midwife visits second pregnancy

Your Guide to Prenatal Appointments

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Typical prenatal appointment schedule

Read this next, what happens during a prenatal care appointment, what tests will i receive at my prenatal appointments, what will i talk about with my practitioner at prenatal care appointments , first trimester prenatal appointments: what to expect, second trimester prenatal appointments: what to expect, third trimester prenatal appointments: what to expect, questions to ask during prenatal appointments  .

Prenatal care visits are chock-full of tests, measurements, questions and concerns, but know that throughout the process your and your baby’s wellbeing are the main focus. Keep your schedule organized so you don’t miss any appointments and jot down anything you want to discuss with your doctor and your prenatal experience should end up being both positive and rewarding.

What to Expect When You’re Expecting , 5th edition, Heidi Murkoff. American College of Obstetricians and Gynecologists,  Having a Baby After Age 35: How Aging Affects Fertility and Pregnancy , 2020. American College of Obstetricians and Gynecologists,  Routine Tests During Pregnancy , 2020. US Department of Health & Human Services, Office on Women’s Health,  Prenatal Care and Tests , January 2019. Journal of Perinatology ,  Number of Prenatal Visits and Pregnancy Outcomes in Low-risk wWomen , June 2016. Mayo Clinic,  Edema , October 2017. Mayo Clinic,  Prenatal Care: 2nd Trimester Visits , August 2020. Mayo Clinic,  Prenatal Care: 3rd Trimester Visits , August 2020. Jennifer Leighdon Wu, M.D., Women’s Health of Manhattan, New York, NY. WhatToExpect.com, Preeclampsia: Symptoms, Risk Factors and Treatment , April 2019. WhatToExpect.com, Prenatal Testing During Pregnancy , March 2019. WhatToExpect.com,  Urine Tests During Pregnancy , May 2019. WhatToExpect.com,  Fetal Heartbeat: The Development of Baby’s Circulatory System , April 2019. WhatToExpect.com,  Amniocentesis , Mary 2019. WhatToExpect.com,  Ultrasound During Pregnancy , April 2019. WhatToExpect.com,  Rh Factor Testing , June 2019. WhatToExpect.com,  Glucose Screening and Glucose Tolerance Test , April 2019. WhatToExpect.com, Nuchal Translucency Screening , April 2019. WhatToExpect.com, Group B Strep Testing During Pregnancy , August 2019. WhatToExpect.com,  The Nonstress Test During Pregnancy , April 2019. WhatToExpect.com,  Biophysical Profile (BPP) , May 2019. WhatToExpect.com,  Noninvasive Prenatal Testing , (NIPT), April 2019. WhatToExpect.com,  The Quad Screen , February 2019. WhatToExpect.com,  Chorionic Villus Sampling (CVS) , February 2019. WhatToExpect.com,  The First Prenatal Appointment , June 2019. WhatToExpect.com,  Breech Birth: What it Means for You , September 2018.

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Prenatal care: Second trimester visits

During the second trimester, prenatal care includes routine lab tests and measurements of your baby's growth. You might consider prenatal testing too.

The goal of prenatal care is to help you and your baby stay healthy during your pregnancy. At best, prenatal care starts as soon as you think you're pregnant. You might have prenatal care visits about every four weeks through the second trimester.

Here's what to expect at your second trimester prenatal visits.

Review the basics

Your healthcare team checks your blood pressure and weight at each visit. These visits focus on:

• Your baby's growth. Your baby's growth is tracked by measuring from your pubic bone to the top of your uterus. This is called the fundal height. After 20 weeks of pregnancy, this number in centimeters often matches the number of weeks you've been pregnant, plus or minus 2 to 3 centimeters.
• Your baby's heartbeat. At second trimester visits, you might hear your baby's heartbeat using a Doppler device. The Doppler device turns the motion of your baby's heart into sound.
• Your baby's movement. You might start to feel flutters or kicks around 18 to 22 weeks of pregnancy. Tell your healthcare professional when they start. Keep in mind that not all pregnant people feel these movements at the same time in their pregnancies.

At your visits, ask about any worries or questions you have. Also, talk to your healthcare team about vaccinations you need.

Think about prenatal testing

During the second trimester, your healthcare team may offer you prenatal tests. These might include:

Genetic tests. Blood tests can screen for conditions caused by genes or chromosomes. These include tests for spina bifida and Down syndrome. If your results cause concern, your healthcare team likely will suggest a diagnostic test, most often chorionic villus sampling or amniocentesis.

During chorionic villus sampling, a sample of the placenta is taken for testing of the baby's chromosomes or genes. During amniocentesis, a sample of the fluid surrounding the baby is removed from the uterus for testing.

• Fetal ultrasound. Fetal ultrasound is an imaging test that uses sound waves to make images of a baby in the uterus. An ultrasound can give useful information about the baby. Fetal ultrasound also might tell you the baby's sex if you want to know.

Blood tests. Blood tests between weeks 24 and 28 of pregnancy can check your blood count and iron levels. And they can screen for diabetes that can start during pregnancy, called gestational diabetes.

Blood tests also check for your Rh status and Rh antibodies. Rh factor is a trait passed through families, also called an inherited trait. Rh factor is a protein found on red blood cells. If your blood is Rh negative, you need a blood test to check for Rh antibodies.

You might have these antibodies if your baby has Rh positive blood and your Rh negative blood mixes with your baby's blood. Without treatment, the antibodies could attack the baby's red blood cells.

Keep your healthcare team informed

The second trimester often brings a renewed sense of well-being. You might have more energy and feel more like being active. For many pregnant people, morning sickness begins to ease during the second trimester. You begin to feel the baby move. And you can see your belly's growth. There's a lot going on.

Tell your healthcare team what's on your mind, even if it seems silly or not important. Nothing is too small when it comes to your health or your baby's health.

• Lockwood CJ, et al. Prenatal care: Initial assessment. https://www.uptodate.com/contents/search. Accessed Feb. 26, 2024.
• Prenatal care and tests. Office on Women's Health. https://www.womenshealth.gov/pregnancy/youre-pregnant-now-what/prenatal-care-and-tests. Accessed Feb. 26, 2024.
• Cunningham FG, et al., eds. Prenatal care. In: Williams Obstetrics. 26th ed. McGraw Hill; 2022. https://www.accessmedicine.mhmedical.com. Accessed Feb. 26, 2024.
• Papadakis MA, et al, eds. Essentials of prenatal care. Current Medical Diagnosis & Treatment 2024. McGraw Hill; 2024. https://www.accessmedicine.mhmedical.com. Accessed Feb. 26, 2024.
• Lockwood CJ, et al. Prenatal care: Second and third trimesters. https://www.uptodate.com/contents/search. Accessed Feb. 26, 2024.

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INTRODUCTION

The goal of prenatal care is the birth of a healthy child with minimal risk for the mother. After the initial prenatal visit, it consists of ongoing evaluation of the health status of both the mother and fetus, counseling about pre- and postpartum issues, and anticipation of problems with intervention, if possible, to prevent or minimize morbidity. Thus, prenatal care represents a series of assessments, discussions, and interventions over time that are often applied by different health care providers. As a result, the quality of prenatal care and the effect of individual components on outcome are difficult to measure.

This topic will discuss prenatal care in the second and third trimesters. Other important issues related to prenatal care are reviewed separately:

● Prenatal care issues at the initial assessment: (See "Prenatal care: Initial assessment" .)

● Specific issues related to prenatal care for patients with multiple gestations: (See "Twin pregnancy: Overview" and "Triplet pregnancy" .)

● Patient education during prenatal care: (See "Prenatal care: Patient education, health promotion, and safety of commonly used drugs" .)

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Prenatal care in your second trimester

The word prenatal means before birth. Trimester means 3 months. A normal pregnancy is around 10 months and has 3 trimesters.

Your doctor or midwife may talk about your pregnancy in weeks, rather than months or trimesters. The second trimester begins at week 14 and goes through week 28.

Routine Prenatal Visits

In your second trimester, you will have a prenatal visit every month. The visits may be quick, but they are still important. It is OK to bring your partner or labor coach with you.

Visits during this trimester will be a good time to talk about:

• Common symptoms during pregnancy , such as fatigue, heartburn, varicose veins, and other common problems
• Dealing with back pain and other aches and pains during pregnancy

During your visits, your doctor or midwife will:

• Measure your abdomen to see if your baby is growing as expected.
• Check your blood pressure.
• Sometimes take a urine sample to test for sugar or protein in your urine. If either of these is found, it could mean you have gestational diabetes or high blood pressure caused by pregnancy.
• Ensure that certain vaccinations are done.

At the end of each visit, your doctor or midwife will tell you what changes to expect before your next visit. Tell your doctor or midwife if you have any problems or concerns. It is OK to talk about any problems or concerns, even if you do not feel that they are important or related to your pregnancy.

Hemoglobin testing. Measures the amount of red blood cells in your blood. Too few red blood cells can mean that you have anemia. This is a common problem in pregnancy, although easy to fix.

Glucose tolerance testing . Checks for signs of diabetes which can begin during pregnancy. In this test, your doctor or midwife will give you a sweet liquid. An hour later, your blood will be drawn to check your blood sugar levels. If your results are not normal, you will have a longer glucose tolerance test.

Antibody screening. Is done if the mother is Rh-negative. If you are Rh-negative, you may need an injection called RhoGAM around 28 weeks of gestation.

Ultrasounds

You should have an ultrasound around 20 weeks into your pregnancy. An ultrasound is a simple, painless procedure. A wand that uses sound waves will be placed on your belly. The sound waves will let your doctor or midwife see the baby.

This ultrasound is typically used to assess the baby's anatomy. The heart, kidneys, limbs, and other structures will be visualized.

Ultrasound can detect fetal abnormalities or birth defects about half the time. It is also used to determine the sex of the baby. Before this procedure, consider whether or not you want to know this information, and tell your doctor or midwife and your ultrasound provider your wishes ahead of time.

Genetic testing

All women are offered genetic testing to screen for birth defects and genetic problems, such as Down syndrome or brain and spinal column defects.

• If your doctor or midwife thinks that you need one of these tests, talk about which ones will be best for you.
• Be sure to ask about what the results could mean for you and your baby.
• A genetic counselor can help you understand your risks and tests results.
• There are many options for genetic testing. Some of these tests carry some risk, while others do not.

Women who may be at a higher risk for these problems include:

• Women who have had a fetus with genetic abnormalities in earlier pregnancies
• Women age 35 or older
• Women with a strong family history of inherited birth defects

Most genetic testing is offered and discussed in the first trimester . However, some tests can be performed in the second trimester or are done partly in the first and second trimester.

For the quadruple screen test , blood is drawn from the mother and sent to a lab.

• The test is done between the 15th and 22nd week of pregnancy. It is most accurate when done between the 16th and 18th weeks.
• The results do not diagnose a problem or disease. Instead, they will help the doctor or midwife decide if more testing is needed.

Amniocentesis is a test that is done between 14 and 20 weeks.

• Your doctor or midwife will insert a needle through your belly and into the amniotic sac (bag of fluid surrounding the baby).
• A small amount of fluid will be drawn out and sent to a lab.

Cell-free DNA testing can sometimes be done instead of amniocentesis. Blood drawn from the mother is the only requirement. Cell-free DNA testing is also called "noninvasive prenatal screening".

When to Call the Doctor

Contact your doctor or midwife if:

• You have any signs or symptoms that are not normal.
• You are thinking of taking any new medicines, vitamins, or herbs.
• You have any bleeding.
• You have increased vaginal discharge or a discharge with odor.
• You have a fever, chills, or pain when passing urine.
• You have moderate or severe cramping or low abdominal pain.
• You have any questions or concerns about your health or your pregnancy.

Alternative Names

Pregnancy care - second trimester

Gregory KD, Ramos DE, Jauniaux ERM. Preconception and prenatal care. In: Landon MB, Galan HL, Jauniaux ERM, et al, eds. Gabbe's Obstetrics: Normal and Problem Pregnancies . 8th ed. Philadelphia, PA: Elsevier; 2021:chap 5.

Hobel CJ, Williams J. Antepartum care. In: Hacker NF, Gambone JC, Hobel CJ, eds. Hacker & Moore's Essentials of Obstetrics and Gynecology . 6th ed. Philadelphia, PA: Elsevier; 2016:chap 7.

Ormandy J. Antenatal and postnatal care. In: Magowan BA, ed. Clinical Obstetrics and Gynaecology . 5th ed. Philadelphia, PA: Elsevier; 2023:chap 23.

Smith RP. Routine prenatal care: second trimester. In: Smith RP, ed. Netter's Obstetrics and Gynecology . 4th ed. Philadelphia, PA: Elsevier; 2024:chap 208.

Williams DE, Pridjian G. Obstetrics. In: Rakel RE, Rakel DP, eds. Textbook of Family Medicine . 9th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 20.

Review Date 5/14/2024

Updated by: John D. Jacobson, MD, Professor Emeritus, Department of Obstetrics and Gynecology, Loma Linda University School of Medicine, Loma Linda, CA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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• Prenatal Care

Your antenatal care

Antenatal care is the care you get from health professionals during your pregnancy.

It's sometimes called pregnancy care or maternity care.

You'll be offered appointments with a midwife, or sometimes a doctor who specialises in pregnancy and birth (an obstetrician).

You should start your antenatal care as soon as possible once you know you're pregnant. You can do this by contacting a midwife or GP, or referring yourself directly to maternity services near you. This is usually done by filling in an online form on your local hospital or NHS trust website.

What is antenatal care?

This is the care you receive while you're pregnant to make sure you and your baby are as well as possible.

The midwife or doctor providing your antenatal care will:

• check the health of you and your baby
• give you useful information to help you have a healthy pregnancy, including advice about  healthy eating and exercise
• discuss your options and choices for your care during pregnancy, labour and birth
• answer any questions you may have

If you’re pregnant in England you will be offered:

• 2  pregnancy ultrasound scans at 11 to 14 weeks and 18 to 21 weeks
• antenatal screening tests  to find out the chance of your baby having certain conditions, such as Down's syndrome
• blood tests to check for syphilis, HIV and hepatitis B
• screening for sickle cell and thalassaemia

You may also be offered antenatal classes , including breastfeeding workshops.

Ask your midwife about classes in your area.

Starting antenatal care

You can book an appointment with your GP or directly with a midwife as soon as you find out you're pregnant. You may be advised to refer yourself to your local maternity service to book your first appointment.

You can ask to be referred to your nearest midwifery service by your GP, midwife, healthcare professional, school nurse, community centre, children's centre or refugee hostel.

You can find your nearest children's centre through your local council .

It's best to see a midwife or GP as early as possible to get the information you need about having a healthy pregnancy.

Some tests, such as screening for sickle cell and thalassaemia , should be done before you're 10 weeks pregnant.

If you have special health needs, your midwife, GP or obstetrician may take shared responsibility for your maternity care.

This means they'll all be involved in your care during pregnancy.

Let your midwife know if you have a disability that means you have special requirements for your antenatal appointments or for labour.

If you do not speak English, tell your midwife.

How many antenatal appointments will I have?

If you're expecting your first child, you'll have up to 10 antenatal appointments.

If you have had a baby before, you'll have around 7 appointments, but sometimes you may have more – for example, if you develop a medical condition.

Early in your pregnancy, your midwife or doctor will give you written information about how many appointments you're likely to have and when they'll happen.

You should have a chance to discuss the  schedule of antenatal appointments with them.

If you cannot keep an appointment, let the clinic or midwife know and rearrange it.

Where will I have my antenatal appointments?

Your appointments can take place at:

• a Children's Centre
• a GP surgery

You'll usually go to the hospital for your pregnancy scans.

Antenatal appointments should take place in a setting where you feel able to discuss sensitive issues, such as domestic abuse, sexual abuse, mental health problems or drugs.

To make sure you get the best pregnancy care, your midwife will ask you many questions about your and your family's health, and your preferences.

Your midwife will carry out some antenatal checks and tests , some of which will be done throughout your pregnancy, such as urine tests and blood pressure checks.

The results may affect your choices later in pregnancy, so it's important not to miss them.

Your midwife will also ask about any other social care support you may have or need, such as support from social workers or family liaison officers.

Questions you might be asked

The midwife or doctor might ask about:

• the date of the first day of your last period
• your health
• any previous illnesses and operations you have had
• any previous pregnancies and  miscarriages
• the ethnic origins of you and your partner to find out whether your baby may be at risk of certain inherited conditions
• whether your family has a history of twins
• your job, your partner's job and what kind of accommodation you live in to see whether your circumstances might affect your pregnancy
• how you're feeling and whether you have been depressed

Your antenatal appointments are an opportunity to tell your midwife or doctor if you're in a vulnerable situation or if you need extra support.

This could be because of domestic abuse or violence , sexual abuse or female genital mutilation .

Antenatal appointments after 24 weeks

From around 24 weeks of your pregnancy , your antenatal appointments will usually become more frequent.

But if your pregnancy is uncomplicated and you're in good health, you may not be seen as often as someone who needs to be more closely monitored.

Later visits are usually quite short and may last 20 to 30 minutes.

Your midwife or doctor will: 

• check your urine and blood pressure
• feel your tummy (abdomen) to check the baby's position
• measure your womb (uterus) to check your baby's growth
• listen to your baby's heartbeat, if you want them to

You can also ask questions or talk about anything that's worrying you.

Talking about your feelings is as important as all the antenatal tests and examinations.

You should be given information about:

• making  your birth plan
• preparing for labour and birth
• how to tell if you're in active labour
• induction of labour  if your baby is overdue (after your expected date of delivery)
• feeling depressed after childbirth – such as the "baby blues" and postnatal depression
• feeding your baby
• vitamin K (given to prevent vitamin K deficiency bleeding in your baby)
• screening tests for newborn babies
• looking after yourself and your new baby

Find out about your schedule of antenatal appointments and what to expect at each one

At each antenatal appointment from 24 weeks of pregnancy, your midwife or doctor will check your baby's growth.

To do this, they'll measure the distance from the top of your womb to your pubic bone.

The measurement will be recorded in your notes.

Your baby's movements

Keep track of your baby's movements.

If you have not felt any movement by the time you are 24 weeks pregnant, contact your midwife who will check your baby’s heartbeat.

After 24 weeks, if your baby’s movements become less frequent, slow down or stop (called reduced foetal movement), contact your midwife or doctor immediately – do not wait until the next day. Your midwife or doctor will check you and your baby and measure your bump.

You'll be offered an ultrasound scan if they have any concerns about how your baby is growing and developing.

Find out more about your baby's movements in pregnancy .

Your maternity notes

At your booking appointment, your midwife will record your details and add to them at each appointment. These are your maternity notes.

Your maternity notes may be in a record book, sometimes called handheld notes. You’ll take your maternity notes home and be asked to bring them to all your antenatal appointments. Take your notes with you wherever you go in case you need medical attention while you’re away from home.

Your maternity notes may be electronic, which you will be able to access digitally.

You can ask your maternity team to explain anything in your notes that you do not understand.

Planning ahead for your appointments

Waiting times in clinics can vary and having to wait a long time for an appointment can be particularly difficult if you have young children with you.

Planning ahead can make your visits easier.

Here are some suggestions: 

• write a list of any questions you want to ask and take it with you
• make sure you get answers to your questions or the chance to discuss any worries
• if your partner is free, they may be able to go with you – this can help them feel more involved in the pregnancy
• you can buy refreshments in some clinics – take a snack with you if you cannot buy one at the clinic

The  National Institute for Health and Care Excellence (NICE) antenatal care guidelines  give useful information on the timing of visits during pregnancy and a description of what will happen each time.

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Antenatal Appointments - What to Expect When You See Your Midwife

This guide covers what happens during your antenatal midwife appointments and includes a midwife appointment schedule.

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What are antenatal appointments?

How many midwife appointments do you have, will i see the same midwife throughout my antenatal appointments, what happens at your first midwife appointment, what questions should i ask at my first midwife appointment, what happens at your 8-10 week appointment, what happens at your 11-14 week appointment, what happens at your 16-week appointment, what happens at your 20-week appointment, what happens at your 25-week appointment, what happens at your 28-week appointment, what happens at your 31-week appointment, what happens at your 34-week appointment, what happens at your 36-week appointment, what happens at your 38-week appointment, what happens at your 40-week appointment, what happens at your 41-week appointment, what you need to know about antenatal appointments, get expert antenatal education with my expert midwife.

This guide covers what happens during your antenatal midwife appointments. It includes a midwife appointment schedule to help you understand what you can expect throughout your pregnancy whenever you have an antenatal appointment, from booking to the birth of your baby.

Anything that happens before labour begins and the birth of your baby is referred to as antenatal. Every appointment you have with anyone to do with your pregnancy during this time – booking, blood tests, ultrasound scans, midwife, obstetrician – comes under that umbrella term of antenatal appointments.

You will have regular pregnancy appointments, and depending on whether your pregnancy is classed as low-risk or high-risk, you may have fewer or more appointments than other pregnant women.

• Antenatal appointments are necessary because, at each contact, you will have some health tests completed to ensure you and your baby are safe and well, physically and emotionally.
• Each appointment is tailored to your pregnancy. They will cover topics specific to your gestation and are designed to prepare you for labour, birth and beyond.
• If your midwife feels it is necessary, they may refer you for more screening tests or to an obstetrician/specialist team for extra care.

As a rule, first-time mums can expect about 10 routine antenatal contacts . In comparison, a mum who has already had a baby will usually be seen less, with 7 scheduled appointments.

The standard antenatal care as recommended by the NHS during pregnancy varies depending on whether:

• This is your first baby
• Your pregnancy is classed as low or high risk
• You need to see your midwife more often due to personal preference

If you are considered to have a high-risk pregnancy, you will be offered additional appointments, usually for ultrasound scans and obstetrician-led antenatal clinics.

The Gold Standard within the NHS is for a small team of midwives to provide all of your antenatal, labour and postnatal care. This is called the Continuity of Carer approach, which has demonstrated improved outcomes and satisfaction.

However, this very much depends on where you live and will be affected by issues such as funding and staffing levels.

Don’t be disappointed if you don’t see the same midwife each time. All of the information about you and your pregnancy is documented either in your handheld notes or on an electronic record which subsequent caregivers can use to inform them of your care plan.

Your first appointment with a midwife is often called your booking appointment, when you will discuss and decide where you would like to birth your baby. You can choose to give birth in a hospital, a birth centre, or at home.

Remember, this is not a contract, plans might change, and you may change your mind.

This appointment takes place around 8-10 weeks of pregnancy, sometimes earlier if you are considered high-risk. The midwife will take a complete and detailed history – medical, lifestyle, obstetric, mental wellbeing, relationships etc.

The minimum you can expect to happen at your booking appointment includes the following:

• A complete and detailed medical and lifestyle history will be taken and documented
• A risk assessment to ensure you follow the right care pathway
• A Venous Thrombo -Embolism (VTE) assessment and referrals, if indicated
• A urine test to check for any signs of infection or protein
• A blood pressure check
• Blood tests offered and taken if consented
• Ultrasound scans and genetic screening will be discussed, offered and booked
• Height, weight, and BMI calculated
• Advice about safe sleeping positions during pregnancy
• Dietary advice – foods and drinks to avoid during pregnancy
• Advice on vitamin supplements
• Exercise and physical wellbeing advice
• You will be provided with an FW8 form for free NHS prescriptions and dental treatment
• Information about antenatal classes
• Opportunity for you to gather information and ask any questions you may have

You will be given either a set of handheld paper notes or access to an app to view your notes, test results, appointments, and leaflets.

Your midwife will conduct health and wellbeing checks at each appointment. And this is also a time for you to gather information which may help when making decisions about your pregnancy and birth. Making a note of any non-urgent questions as you think of them – either in a notebook, on the back of your paper notes or your phone – is valuable preparation for your appointment.

Any urgent concerns at this stage should go through your local Maternity Assessment Centre or Unit.

Your first appointment may feel overwhelming. With all of the information you receive, you may come out thinking, “I wish I had asked that!” So here’s a list of frequently asked questions you may want to consider:

• When will I meet my Community Midwife?
• How often will I be seen during my pregnancy?
• Will I see the same Midwife throughout my pregnancy?
• Will I have any scans? When? Can anyone else accompany me?
• Where will I birth my baby?
• What if I have any concerns about my pregnancy? Who do I contact?
• Should I be taking pregnancy supplements?
• Can I travel abroad during my pregnancy?
• What foods should I avoid during pregnancy?
• Can I continue exercising during pregnancy?
• Antenatal classes? When should I book them?
• Is it safe to continue taking prescription medications?
• Is sex safe during pregnancy?
• How will I know my baby is ok in pregnancy?

During this appointment, a midwife will take a comprehensive history of your mental health, previous pregnancies, lifestyle, family and medical wellbeing. You will also be offered screening tests, such as ultrasound scans, blood tests and a urine test.

You can expect the following:

• To discuss the schedule of your antenatal appointments
• To discuss and choose where you would like to give birth
• Learn any symptoms that may be of concern during pregnancy
• To discuss your partner and their family history
• To undergo risk assessments for Pre-eclampsia , Gestational Diabetes and VTE (blood clots)
• A discussion to ensure you are on the right care pathway
• A calculation of your height, weight and BMI
• A blood pressure test
• A discussion about antenatal classes in your area

During the 11 - 14 week midwife appointment, you will have a dating ultrasound scan with a sonographer specialising in pregnancy to establish your EDD (Expected Due Date).

At 14 weeks, you may also be offered an appointment to have a blood test to check the baby's blood group and to check if your blood group is rhesus negative, to identify if you should be offered Anti-D prophylaxis.

At your 16-week appointment, you will undergo a health check, a scan and receive your blood test results. It may be possible for the midwife to hear the baby’s heartbeat at this gestation using a Doppler (handheld listening device).

You will be offered a Foetal Anomaly Ultrasound Scan (FAS) at the hospital. And, should you want to know, you may be able to find out the gender of your baby.

• You will also be advised to book a Whooping Cough vaccination with your GP.
• At this stage, you may start to feel the baby's movements, but don’t be concerned if this doesn’t happen until later.
• You will receive a MatB1 certificate to hand to your employer or the Job Centre, which entitles you to either Statutory Maternity Pay (SMP) or Maternity Allowance (MA).

Only first-time mums-to-be will have this appointment in their schedule. You can expect the following during this midwife appointment:

• A health check
• To receive scan results
• Labour and birth preparation advice
• A discussion around antenatal classes
• A discussion around foetal movements

Read our guide on the labour and birth care choices available to you.

The 28-week maternity appointment is a major appointment where you can expect the following:

• Checking foetal movements
• Repeat blood tests
• An abdominal palpation examination
• Plotting symphysis fundal height (SFH) on your Personalised Growth Chart (PGC)

At this stage, you will be offered an Anti-D prophylaxis if indicated.

You may also be offered an Oral Glucose Tolerance Test (OGTT) in an antenatal clinic if indicated to check for Gestational Diabetes.

By now, you should be feeling your baby move. If you have any concerns about the baby’s movements, you may be advised to have a CTG (Cardiotocograph) monitoring of their heartbeat to assess their wellbeing.

Usually, only first-time mums-to-be will have this midwife appointment. You can expect the following:

• SFH plotted on your Personal Growth Chart

Your baby will usually have developed a pattern of what movements are “normal” for them. Monitor these movements, and if you are ever concerned that the pattern of movements has changed, then you should call the Maternity Assessment Centre/Unit (MAC/MAU) for an assessment.

Changes to look out for include:

• Movements have slowed down
• You have not felt the baby move
• Excessive continuous movements

At this appointment, you can expect the following:

• SPH plotted
• Discussion about how to care for your newborn and feeding
• Discussion about screening test results from the 28-week blood tests

Read our guides on breastfeeding and colostrum harvesting .

• If you are considering an elective Caesarean, you will have this appointment with an obstetrician to discuss your options
• Confirmation of the presentation of your baby (head-down, breech or transverse) and referrals to discuss options with an obstetrician if the baby is not head-down
• If you are booked for a home birth, this appointment should be at home so the midwife can see how the space will work during labour and delivery

At this stage, you can expect the following:

• To confirm birth preferences and place of birth

This appointment is usually just for first-time mums-to-be. You can expect the following:

• A discussion about inducing labour
• Offered a membrane sweep
• Booking an induction of labour

Please note: Mums-to-be who have already had a baby usually will not have an appointment at 25, 31 and 40 weeks and will be offered a membrane sweep from 41 rather than 40 weeks gestation.

Midwife appointment schedules are fairly standard throughout the NHS, and your midwife should be able to explain this at your booking appointment. However, that schedule may be amended during pregnancy if your risk level increases or decreases.

Antenatal appointments ensure you are kept safe and healthy throughout your pregnancy and help prepare you for labour and transition to parenthood.

As part of routine care, your midwife should discuss antenatal classes in your local area and explain how and when to book them. It is entirely your choice as to which classes you enrol on; NHS or private, face-to-face or virtual, free or paid, and will be determined by your specific needs and wants and what is offered locally.

My Expert Midwife has launched online antenatal classes covering 137 topics over 7.5 hours that you can take at your own pace. Our team of in-house registered midwives, consultant obstetrician and anaesthetist have written and presented all of the antenatal course material based on the most up-to-date evidence.

You can view it in your own time, at your own pace, as many times as you wish. With the classes, you will get access to our online forums and communities where you will get to chat with other pregnant families-to-be as well as with our Midwives.

For more expert advice from our midwives, visit our blog .

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Maternity - Pregnancy, part 2: Prenatal Care: 1st, 2nd, and 3rd Trimester Visits

Pregnancy involves a lot of OB/GYN visits! This article gives an overview of all the appointments that need to happen during pregnancy—this article is an overview, and later on in this series, we cover some of these exams more in depth.

This series follows along with our Maternity Nursing Flashcards which are intended to help RN and PN nursing students study for nursing school exams, including the ATI, HESI, and NCLEX.

Maternity Nursing - Flashcards

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First Trimester Visit(s)

The first trimester of pregnancy is the first 12 weeks (months 1, 2, and 3) and the first prenatal visit will take place during this time. A patient may have more than one visit in their first trimester, but it depends on when they realize that they may be pregnant.

During the first trimester visit, the provider will obtain the pregnant patient's obstetric history, calculate the estimated date of delivery, run important laboratory tests, perform a transvaginal ultrasound, and give the patient some initial maternal teaching.

Until approximately 28 weeks, the pregnant patient will have monthly visits.

Obstetric history

During the first trimester visit(s), the care team will gather the patient's obstetric history, meaning how many pregnancies and of what type. There is a special acronym for this, GTPAL . Check out our next video to learn more!

Calculating estimated date of delivery

During the first trimester visit(s), the provider or care team will calculate the patient's estimated date of delivery—when baby is expected to arrive! One useful way of calculating this is with Naegele's rule .

First trimester visit labs and diagnostics

During the first trimester visit(s), the patient will have some important labs and diagnostic testing done, including the following:

• Complete blood count
• STI & HIV testing
• Blood typing, including Rh factor
• Rubella titer
• Hepatitis B
• HCG (for high risk patients).

Transvaginal ultrasound

A transvaginal ultrasound is a test that gives a view of the patient's uterus, ovaries, fallopian tubes, cervix, and the surrounding area. During the first trimester visit(s), the patient may get a transvaginal ultrasound to confirm pregnancy, site of implantation (to ensure it's a safe pregnancy, not ectopic). Transvaginal means across or through the vagina, so the ultrasound device is placed inside the vagina, as opposed to an abdominal ultrasound wherein the device is against the abdomen.

A transvaginal ultrasound makes it much easier to get detailed imagery of the uterus and fallopian tubes than an abdominal ultrasound. Catching an ectopic pregnancy in the earliest stage of pregnancy is crucial to prevent harm to the patient.

First trimester maternal patient teaching

During the first trimester visit(s), you will give the pregnant patient some patient teaching about what to expect during their pregnancy. This includes nutritional guidance , weight gain, warning signs of complications, and expected side effects. In our Maternity Nursing Flashcards we cover patient teaching in detail. You can check out Part 4: Maternal Teaching: Nutrition/Weight Gain, Warning Signs, Unpleasant Side Effects which follows along with our flashcards.

Second Trimester Visits

The second trimester of pregnancy is from week 13 - 24 (months 4, 5, and 6) and there will be some important visits during this time.

Starting in the second trimester, the fetal heart rate will be assessed via doppler and fetal vital signs and weight will be obtained at each visit.

14 - 18 weeks (month 4)

During 14 - 18 weeks of pregnancy, the patient will get MSAFP testing done, followed up with amniocentesis if anything abnormal is found, and a gestational diabetes screening.

MSAFP testing

During 14 - 18 weeks of pregnancy, the patient may get a maternal serum alpha-fetoprotein (MSAFP) test , which is a test for genetic abnormalities like neural tube defects and Down syndrome.

Amniocentesis

During 14 - 18 weeks of pregnancy, if a patient has an abnormal result on their MSAFP test, they may require an amniocentesis , which is an invasive procedure wherein some amniotic fluid is removed from the uterus with a long needle and tested for genetic abnormalities.

Gestational diabetes test

If a patient is at high risk for gestational diabetes , they may be tested during 14 - 18 weeks of pregnancy with an oral glucose tolerance test . If a patient does not have higher risk, this test happens later.

18 - 22 weeks (month 5)

During 18 - 22 weeks of pregnancy, the patient will have an ultrasound to assess for any fetal abnormalities, and the fundal height will start to be measured during this time.

During 18 - 22 weeks of pregnancy, a patient will have an ultrasound as a standard part of prenatal care and to check for abnormalities that may require additional testing. By the time the patient has reached the second trimester of pregnancy, their ultrasounds will usually be abdominal rather than transvaginal.

Fundal height measurement

During 18 - 22 weeks of pregnancy, the patient will begin to need a fundal height assessment. Beginning at 18 weeks of pregnancy, the gestational age of the pregnancy should correlate to the fundal height in centimeters plus or minus two weeks

What is the fundus?

The fundus is not just a word that some nursing students and nurses find hilarious; it's the topmost part of the uterus. Fundal height is measured from the fundus to the pubic symphysis (middle anterior pelvis, above the vulva).

22 - 24 weeks (month 6)

During 22 - 24 weeks of pregnancy, the patient will need a glucose tolerance test, and for first pregnancies and those at risk for preterm labor, cervical length will start to be measured during this time.

Glucose tolerance tests

While it was only high-risk patients who were tested in month 4, in month 6 (22 - 24 weeks) of pregnancy, all patients will be given a 1-hour glucose tolerance test to test for gestational diabetes . If it is needed, it will be followed up with a 3-hour glucose tolerance test.

Cervical length

During 22 - 24 weeks of pregnancy, patients who are on their first pregnancy may have a transvaginal ultrasound done to have the length of the cervix assessed. This can help to identify risk factors for preterm labor. As long as the result of this test is normal, and the patient does not have preterm labor on their first pregnancy, this exam won't be repeated in the future.

Third Trimester Visits

The third trimester of pregnancy is from week 25 - 40 (months 7, 8 and 9) and there will be some important prenatal visits that take place during this time. After approximately 36 weeks, prenatal visits will be weekly until delivery.

At 28 weeks of pregnancy, Rhogam will be administered to Rh-negative patients, and visits will begin to happen every 2 weeks.

In the first trimester, patients were tested for Rh factor , which checks for maternal-fetal blood type incompatibility. If a pregnant patient is Rh negative (blood type incompatible), they will be administered Rhogam at 28 weeks and within 72 hours of delivery.

30 - 32 weeks

During 30 - 32 weeks of pregnancy, patients will need to begin kick counts, receive a TDaP, and undergo non-stress tests if they have a high-risk pregnancy.

Third trimester maternal patient teaching

At 30 weeks, patients should be taught to perform kick counts, which is exactly what it sounds like—How many times does the baby kick? This is important knowledge as it helps to assess the fetal well-being.

TDaP vaccine

At 30 weeks, patients can be given the tetanus, diphtheria, and acellular pertussis (TDaP) vaccine. If it is given in the third trimester, it can impart some protection to the baby. If not given then, it will be given after delivery.

Non-stress tests

A nonstress test is a non-invasive test done in the third trimester to measure fetal heart rate response to fetal movement.

35 - 37 weeks

During 35 - 37 weeks of pregnancy, patients may need to have a vaginal/rectal Group B Strep swab obtained, and at approximately 36 weeks, their visits will need to occur weekly until delivery.

Group B strep swab

Group B streptococcus beta-hemolytic (GBS) is a bacterial infection that can be passed to a child during the birthing process that can cause life-threatening newborn infections. During 35-37 weeks, a patient should have a rectal and vaginal swab for this bacteria. If the patient has Group B strep, they can be treated at the time of delivery.

Full Transcript: Maternity - Pregnancy, part 2: Prenatal Care: 1st, 2nd, and 3rd Trimester Visits

Hi, I'm Meris, and in this video, I'm going to be talking about what happens at OB/GYN visits in the first, second, and third trimesters. I'm going to be following along using our maternity flashcards. These are available on our website leveluprn.com. And if you already have a set of your own, I would absolutely invite you to follow along with me.

So let's go ahead and jump right in with what happens at the first-trimester visit.

So I say visit because typically there's only one. However, it just depends on when a patient realizes that they may be pregnant. So the first visit, the initial visit, should be done before 12 weeks of gestation. However, if that patient does come in and they're very early, let's say six weeks, they'll probably come back again four weeks later. But for most people, they have just the one.

Now, this is a really big visit for a lot of reasons.

First is, baby is too small for us to use a Doppler to assess the heart rate. So instead, we have to do an ultrasound. That's the only way to confirm cardiac activity at this point. So there will be an ultrasound to assess that the fetus has a heartbeat and what that rate is.

And then going forward, the heart rate will be assessed with a Doppler from the outside.

The other thing is that this is where a lot of labs and diagnostic testing is performed. So on this card, you can see that there is a heading called labs. And on here, we have a lot of big ones.

I want to call your attention to CBC [complete blood count]. Do we already have a problem with anemia? Do we already have an infection? We want to know that.

STI testing. In a lot of states, this is mandatory. So be familiar with your state's laws.

A Pap test. If my patient has not had a Pap test recently or is due for one, then we're going to do it at this visit.

Blood typing. Blood typing, including Rh factor. This is very important. And we will talk about that in a little bit.

And then we're going to be testing for hepatitis B, or hepatitis B immunity, for HIV.

And then if your patient is high risk, as in they may have had multiple miscarriages or something along those lines, they may also have serial, meaning in a row, a few HCG, which is the pregnancy hormone levels drawn to be sure that the pregnancy seems to be developing appropriately.

Also, maternal teaching will be done, and we'll talk about that in a later video.

And then, until 28 weeks - we have a line on here - but until 28 weeks, these visits will be monthly, so every four weeks. There's not a lot to see or do at these visits in the early days because baby is very little.

So let's move on to the second trimester. Now, when you look at the second-trimester card, whoo-hoo-hoo, there is a lot of bold red text on here. And to me, that means I should really know this card, and probably want to star and highlight this card because it might be really important for me to know.

So, from 14 to 18 weeks, anywhere in that time, MSASP, maternal serum alpha-fetoprotein testing will be done. We'll talk about that in a later video. But that is when that will occur.

If there is an abnormal MSASP, then we can progress to an amniocentesis. Again, we'll talk about that later.

And then gestational diabetes screening happens at this early time for patients who are high risk, as in they had gestational diabetes in a prior pregnancy. Maybe they were prediabetic before getting pregnant. Maybe they have a strong family history. We're going to test them much earlier than everybody else.

Now, from 18 to 22 weeks, we have a lot.

We will have an ultrasound. This is commonly called an anatomy scan because it is looking for abnormalities in the fetal anatomy. So we're going to check everything out with baby, see if we have any sort of congenital heart defects, neurological defects, anything that can be seen on the ultrasound.

Fundal height assessment will begin at this point. This is very important. Fundus height means I'm measuring from the pubic symphysis all the way up to the fundus. The fundus is the topmost part of the uterus.

And we're going to measure this in centimeters. The gestational age of the pregnancy should correlate to the fundal height in centimeters plus or minus two weeks, beginning around 18 weeks, so from 18 to 32 weeks. Let's say I'm 24 weeks pregnant. My fundal measurement should be about 24 centimeters. Anything drastically less or more is cause for further investigation.

And then, from 22 to 24 weeks, this is where a routine gestational diabetes screening will happen. This is going to be a one-hour oral glucose tolerance test. And then follow up with a three-hour if needed. We'll talk about that in a later video.

And for first-time pregnancy, it's very commonly there will be an ultrasound done, a transvaginal ultrasound, to assess the length of the cervix. This can help us to identify risk factors for preterm labor. But as long as that is normal and the patient does not have preterm labor this pregnancy, that won't be repeated in the future.

Now, let's talk about the third trimester. Again, we can see a lot of bold red text on here. So let's go through it.

If the patient is Rh-negative, which we know because we did the blood type at the first visit, if our patient is Rh-negative, they will receive RhoGAM, or the RhoGAM is the anti-D antibody. So this is going to help to suppress that. That will be administered to Rh-negative patients at 28 weeks.

From this point on, all visits are going to be every two weeks. So now, 28 weeks. We're going to be seen at 30 weeks, and then 32 and 35.

So then, 30 to 32 weeks, this is going to be huge education for your patients. At 30 weeks, your patient should be performing kick counts. They are what they sound like. It's counting how many times the baby kicks. This is important. It helps us to assess the fetal well-being. So that's going to be something that we want to start at 30 weeks.

Also, at thirty weeks, we can give TDaP vaccine to the pregnant patient. So that's the tetanus, diphtheria, and acellular pertussis vaccine. If given in the third trimester, it does impart some protection to the baby.

And then, NSTs. Nonstress test may be performed at this time if they are indicated from 35 to 37 weeks.

Really, really important. Listen to me. 35 to 37 weeks, we are going to do a vaginal and rectal swab for group B, beta hemolytic strep. So you will hear this just called group B strep. And it's a swab of the vagina and rectum. This is a bacteria that some people just carry. But if the patient has it, we need to treat them at the time of delivery.

And then starting at 36 weeks, visits with the provider will be weekly. So 36, 37, 38, 39, 40, and beyond until the patient delivers, just depending on when that baby comes.

So I hope that review kind of comprehensively of what happens throughout the three trimesters of prenatal care was helpful. We're going to talk a lot more about what all of those things are and what they mean in future videos. So be sure that you subscribe so that you're the first to know when they are alive on our channel. If this review was helpful for you, I would love it if you could like this video so that I know. And if you have a great way to remember something or a really good story, I would love to hear it below. Please leave us a comment so we know. All right. Thanks so much, and happy studying.

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Ready Steady Baby

Your antenatal care.

In Scotland, the NHS provides pregnancy, labour and postnatal (after birth) care.

During your pregnancy, you’ll have regular antenatal (pre-birth) appointments with your midwife or obstetrician.

Some of your appointments will be face to face at a midwife hub, hospital or at home.

Other appointments may be video calls using NHS Near Me.

More information about NHS Near Me video appointments

More about antenatal care and classes during COVID-19

Your rights

You’ll be given information about your rights and choices, to help you make your own decisions about treatment and care.

You have the same rights regardless of your age, sexuality, race, religion, or any other reason. If you feel you are being treated differently, speak to your midwife, GP, or a friend or family member you trust.

Maternity Action has more information about   your maternity rights .

Antenatal appointments

You’ll usually have 8 to 10 appointments with your primary midwife during your pregnancy. Your primary midwife is the midwife you see most often.

Some women may need more, or might have appointments with other members of their healthcare team.

Your first main appointment is called your   booking appointment.

It’s important to go to all appointments. If you can’t attend an appointment for some reason, then it’s okay to rearrange it for another time close to the original appointment.

These appointments are important for you to build a relationship with your primary midwife. With your permission, your primary midwife will:

• monitor how you and your baby are doing
• support you to have the information you need to make decisions about your care, birth, and becoming a parent
• pick up any issues or concerns early

You’ll be offered some tests each time, such as:

• blood pressure
• growth check
• a urine test

At your appointment, you can:

• ask questions
• talk about your options throughout pregnancy, birth and after you have your baby
• explore any benefits or risks
• be supported to make decisions that feel right for you and your baby
• get advice and support about anything you’re worried about
• talk about how you’re getting on

Growth checks

How a baby grows is different for each woman, and your midwife will do a growth check at each antenatal visit.

One way growth is measured is by measuring the size of your womb or baby bump. This is known as fundal height. The measurements are recorded on a chart and can be used to monitor how your baby is growing.

You might also be offered a growth scan. If you are offered a growth scan, your midwife will explain why.

Read more about how your baby develops

Antenatal classes

Your midwife will tell you about antenatal classes at your appointments.

Antenatal classes, often called parent education classes, will:

• help you prepare for being a parent
• help you plan for the birth and the first few weeks with your baby

The classes are a great opportunity for dads, partners or any person you choose to support you to get involved too.

Groups and classes may be in person or may be virtual, so you can access them on your phone, tablet, or laptop.

Learn more about antenatal classes during COVID-19

Your maternity notes

All of your antenatal care is recorded in your electronic Scottish Women-Held Maternity Record (SWHMR), commonly known as maternity notes. You may be given an app to use instead, which links to your electronic record.

Ask your midwife to go through your maternity notes with you on the app or on paper.

Your maternity notes have information about:

• any previous pregnancies
• your current and previous health and wellbeing
• your test results
• how your baby is growing and your pregnancy is progressing
• your maternity unit, your primary midwife and how to contact them
• your ongoing plan of care
• your birth plan

Your maternity notes also have contact details for your primary midwife and maternity unit.

You might see medical words and abbreviations in the record. If you’re not sure what these mean or if you want more information, ask your midwife to explain.

Looking after your notes

You should:

• take your maternity notes with you to all your appointments (whether they’re on paper or an app)
• keep them in a safe place
• have them with you when labour starts
• take them with you if you’re away from home for any length of time

This helps to make sure all health professionals that care for you know how your pregnancy has been, so they can give you the best possible care.

Screening tests and scans

You’ll be offered tests during your pregnancy to make sure you and your baby are healthy and well.

If any issues or health conditions are found, this will be discussed with you. You’ll be supported to make choices that feel right for you and your baby.

Screening tests and scans can also help you and your baby be monitored more often and receive treatment quickly, if it’s needed. This can help to prevent serious illness and can save lives.

Read more about tests in pregnancy

Home blood pressure and urine monitoring

Your blood pressure and urine will be checked regularly throughout your pregnancy.

Your maternity care team may discuss home monitoring with you and help you decide whether it feels right for you and your baby.

More about home blood pressure and urine monitoring

Paying for care

If you don’t usually live in Scotland, you’ll probably have to pay for NHS maternity care, although there are a few exceptions to this.

You must not be refused treatment or have it delayed because you need to pay.

Read information from the Scottish Government on accessing care for overseas visitors

Source: Public Health Scotland - Opens in new browser window

Last updated: 25 January 2023

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Antenatal appointments: why they’re important

Antenatal appointments are appointments you have during pregnancy.

Going to your antenatal appointments right from the start means that your doctor or midwife can check  how you and your baby are going .

Your doctor or midwife can follow your baby’s growth and monitor you both for any  health problems or risks that might develop, including risks to your physical and emotional health. If there’s a problem, it can be picked up and treated early.

At antenatal appointments, you can  talk about any concerns or ask questions – for example, about pregnancy, labour, birth and early parenting. And you can get health and lifestyle support – for example, help to gain weight safely or quit smoking.

Antenatal appointments are a chance to look at information about your health and pregnancy with your doctor or midwife and make decisions about your pregnancy care. This might include  decisions about screening tests and the place you want to give birth . Some of these appointments and tests need to happen at certain times in pregnancy.

If you think you might be pregnant or you’ve just found out you’re pregnant , see your GP to start your pregnancy care. Your GP will recommend some routine tests, check your health, refer you to a midwife or obstetrician, and help you make a booking for a place of birth.

Who you’ll see at antenatal appointments

If you’re planning to give birth at a  public hospital , your appointments will probably be with a  midwife or doctor at the hospital or at a clinic in the community.

If you’re in  shared care , some of your appointments will be with your GP. Some will be with a midwife or hospital doctor.

If you’re planning to give birth at a birth centre , your appointments will probably be with a midwife at the birth centre.

If you’re planning to give birth at a private hospital , your appointments will probably be with your obstetrician at the obstetrician’s consulting rooms. Many private obstetricians employ a midwife in their rooms, whom you’ll see during your pregnancy as well.

If you’re planning a  homebirth , your appointments will be with a midwife in your home, at a hospital or in the community.

If you’re not confident speaking English, ask for an interpreter – either in person or on the phone. You don’t have to pay to use an interpreter. Also, a multicultural health worker might be able to help you with booking your appointments, filling out forms and getting to your appointments.

What will happen at antenatal appointments

Depending on how many weeks pregnant you are, your doctor or midwife might check or talk about your:

• stage of pregnancy and work out when your baby is due
• general health and  medical history , including previous pregnancies and births
• emotions, mood and mental health, and screen you for  anxiety and depression
• medicines, including prescription, herbal and over-the-counter medicines
• cervical screening test history, and book you in for a screening test very early in pregnancy if you need it
• blood pressure
• weight and how you can achieve healthy weight gain.

Your doctor or midwife might also:

• measure your tummy and listen to your baby’s heart beat
• listen to your heart and lungs
• recommend blood tests, screening tests and other tests and talk about test results
• talk about healthy eating and also foods that aren’t recommended in pregnancy
• ask about your lifestyle and help you get support for lifestyle changes like quitting smoking or giving up alcohol or other drugs
• ask about your work and home environment and your family situation and support
• recommend antenatal classes so you can learn about things like labour, birth, breastfeeding and early parenting.

Further into your pregnancy , your doctor or midwife might talk to you about or check:

• your emotions, including whether you have any concerns about your safety
• your baby’s movements, growth, position and heart
• labour signs, labour pain, and your preferences for labour and giving birth
• complications or problems – for example,  premature birth
• your plans for taking your baby home (if you’re giving birth in a hospital or birth centre)
• your plans for  breastfeeding or  formula-feeding your baby and give you information about this choice.

If your doctor or midwife doesn’t talk about something you want to know, it’s OK for you to ask questions and get information.

And if you think of any questions in between appointments, it helps to write them down so you can remember to ask your midwife or doctor at your next visit.

If you’re worried about becoming a parent or there are problems in your relationship, including family violence , it’s a good idea for you to talk about this too. In fact, most public hospital antenatal services ask you about family violence during pregnancy. This is so you can get support if you need it.

How many antenatal appointments?

Your doctor or midwife will give you a plan of appointments at your first pregnancy visit. This might change as your pregnancy progresses.

If you find out you’re pregnant within the first 6 weeks of pregnancy and you have a uncomplicated pregnancy , you’ll probably have 10-12 appointments with your doctor or midwife during your pregnancy if it’s your first baby.

You might have 7-10 appointments if you’ve had a previous pregnancy with no complications.

Many women have visits every 4-5 weeks until 28 weeks of pregnancy, then visits every 2-3 weeks until 36 weeks of pregnancy. After this, you’ll probably have weekly or fortnightly visits until birth.

The number and timing of pregnancy appointments could be more or less than this , depending on your health and your baby’s health. For example, if you have a complex pregnancy you might have more pregnancy appointments. Your doctor or midwife will talk with you about the appointments you need and why.

Some women experience high levels of worry or  stress during pregnancy . Seeing your midwife or doctor more frequently can help with managing stress or other concerns during pregnancy. You can ask your midwife or doctor about whether more pregnancy appointments might be good for you.

Taking a support person to your pregnancy appointments

If possible, it’s a good idea to ask  your partner, a friend or a family member to go with you to pregnancy appointments.

Your  support person can help you remember information, share the experience with you and provide comfort and encouragement.

Your partner or support person might be asked to leave the room for a short time during some of your pregnancy appointments. This is so your health professional can talk one on one with you about how things are going at home.

Some services offer appointments in the evenings or weekends. This might make it easier for you and your support person to go to appointments together. You can ask your health professional if these hours are available.

It’s also OK to go to appointments on your own.

Have a Healthy Pregnancy

Take Action

Health care during pregnancy is called prenatal care. Getting prenatal care can help you have a healthier baby. It also lowers the risk of your baby being born too early, which can lead to health problems for your baby.

During prenatal care, your doctor or midwife can find any health problems that may come up. A midwife is a health professional who provides health care during pregnancy and helps pregnant people during childbirth.

Get regular prenatal checkups.

Schedule a visit with your doctor or midwife as soon as you know you're pregnant — or if you think you might be. You'll need many checkups with your doctor or midwife during your pregnancy. Don't miss any of these appointments — they're all important.

Be sure to get all the medical tests that your doctor or midwife recommends. Early treatment can cure many problems and prevent others.

Take steps to have a healthy pregnancy.

To keep you and your baby healthy, it's important that you:

• Don’t smoke or drink alcohol
• Eat healthy and get enough folic acid
• Stay physically active

Get more tips for a healthy pregnancy:

• If you just learned that you're pregnant, find out what to do next
• Check out these tips for staying healthy and safe during pregnancy

Topics to Discuss

Make the most of each visit with the doctor or midwife..

Talk with your doctor or midwife about:

• Your personal and family health history, including any chronic (long-term) health problems or surgeries you've had
• When you need to get medical care for issues that can come up — like high blood pressure, dizziness, swelling, pain, bleeding, or contractions
• When and where to go for emergency care during your pregnancy
• Any prescription and over-the-counter medicines that you take — as well as vitamins, supplements, and herbs
• Healthy weight gain during pregnancy

These visits are also a great time to discuss:

• Questions you have about pregnancy, childbirth, and breastfeeding
• How to get help buying food if you need it — including how to get help from a program called WIC (Women, Infants, and Children)
• Anything that’s bothering or worrying you

If you're worried about your health during pregnancy, don't wait to ask for help.  Learn more about pregnancy complications and when to call your doctor or midwife .

Make a birth plan.

A birth plan describes what you want to happen during childbirth and after your baby's birth. It can include:

• Where you'd like to give birth — for example, at a hospital or birthing center
• Who you want with you for support (like your partner, family member, or close friend) before, during, and after childbirth
• How you want to manage pain during childbirth
• Who you want to help you make important medical decisions during childbirth
• Your plan to breastfeed after your baby is born

Talk with your doctor about depression.

Many people experience depression during and after pregnancy. Talk with your doctor about your risk for depression and whether you need counseling to help prevent it.

Medical Tests

Get important medical tests..

During your pregnancy, your doctor or midwife will recommend medical tests that all people need as part of routine prenatal care. You’ll need to get some tests more than once.

These tests give your doctor or midwife important information about you and your baby. The tests will check your blood or urine (pee) for:

• Rh factor (a protein some people have in their blood)
• Hepatitis B [PDF - 859 KB]
• Urinary tract infection (UTI)
• Signs of past rubella infections (German measles)
• Group B strep

If you're younger than age 25 or have certain risk factors, your doctor or midwife may also check for other sexually transmitted infectionss (STIs), also called sexually transmitted diseases (STDs).  Learn more about STIs during pregnancy .

Your doctor or midwife will also check your blood pressure regularly during your pregnancy. They may recommend that you check your own blood pressure at home using a monitor you can buy at a drug store. High blood pressure during pregnancy can be a sign of preeclampsia, a health problem that some pregnant people develop.  Learn more about preventing preeclampsia .

Talk about your family history.

Share your personal and family health history with your doctor or midwife. This will help you and your doctor or midwife decide whether you need any other tests, like genetic testing.  Find out more about genetic testing .

Diabetes Testing

Get tested for gestational diabetes..

All pregnant people need to get tested for gestational diabetes between 24 and 28 weeks of pregnancy. Gestational diabetes is a type of diabetes that some people develop during pregnancy.

Pregnant people at high risk for type 2 diabetes may need to get tested earlier than people at normal risk.  Find out about your risk for type 2 diabetes .

What do I need to know about gestational diabetes?

Gestational diabetes can lead to health problems for moms and babies — both during and after pregnancy. It’s important to get tested so that you and your doctor or midwife can take steps to protect you and your baby.

You're at higher risk for gestational diabetes if you:

• Have overweight or obesity
• Have a family history of diabetes
• Are over age 25
• Are African American, Hispanic or Latino, American Indian, Alaska Native, Native Hawaiian, or Pacific Islander
• Had gestational diabetes during an earlier pregnancy
• Have had a baby weighing over 9 pounds
• Have polycystic ovary syndrome (PCOS)

You can reduce your risk for gestational diabetes by eating healthy and staying active during pregnancy.

• Learn more about gestational diabetes
• Ask your doctor about getting tested for gestational diabetes

Cost and Insurance

What about cost.

Under the Affordable Care Act, insurance plans must cover routine prenatal tests. Depending on your insurance plan, you may be able to get these tests at no cost to you. Check with your insurance company to find out more.

To learn more, check out these resources:

• Free preventive care for women covered by the Affordable Care Act
• How the Affordable Care Act protects you
• Understanding your health insurance and how to use it [PDF - 698 KB]

If you don’t have health insurance, you can still get help paying for medical care during pregnancy:

• Get connected with free or low-cost services in your state by calling 1-800-311-BABY (1-800-311-2229)
• Find a health center near you and ask about prenatal care

Learn more about health insurance options for pregnant people.

Get Prenatal Care

There are lots of things you can do today to help you have a healthy pregnancy and a healthy baby.

Get regular prenatal care.

Plan on getting a prenatal checkup at least once a month for the first 6 months (through week 28) — and more often during the last 3 months of your pregnancy (after week 28).  Learn more about prenatal care .

Get important vaccines.

All pregnant people need whooping cough and flu vaccines (shots). Talk to your doctor or midwife about getting other vaccines to help protect you and your baby.  Learn more about vaccines for adults . 

Take charge of your health care.

Speak up and ask questions when you're with your doctor or midwife. When you play an active role in your health care, you help make sure that you and your growing family will get good care.  Find out how to take charge of your health care .

Keep track of your baby’s movement.

Sometime between 16 and 28 weeks of pregnancy, you'll probably start to feel your baby move. Keep track of how often your baby moves. If you think your baby is moving less than usual, call your doctor or midwife.

Don't Smoke, Drink Alcohol, or Use Drugs

Don’t smoke, drink alcohol, or use drugs..

One of the best ways to protect you and your baby is to stop smoking, drinking alcohol, and using drugs before you become pregnant — or as soon as possible during your pregnancy.

There's no safe amount to drink or smoke while you're pregnant. Both can harm your baby’s health. Talk with your doctor or midwife about ways to help you quit.

Quitting all forms of tobacco products, including e-cigarettes (vapes), is best for you and your baby. Secondhand smoke (smoke from other people’s cigarettes) can also put you and your baby at risk for health problems. Stay away from cigarette smoke during your pregnancy.

Using drugs during pregnancy — including opioid pain medicines and marijuana — can also put your baby’s health at risk. If you’re pregnant and using drugs, talk with your doctor right away.

Learn more:

• Pregnant? Don’t Smoke!

Quit Smoking

• Alcohol Use in Pregnancy
• What You Need to Know About Marijuana Use and Pregnancy
• Pregnancy and Opioid Pain Medications [PDF — 0.99 MB]

Eat Healthy and Stay Active

Get the nutrients you need..

Making healthy food choices and taking supplements as needed can help you gain weight in a healthy way, feel good while you're pregnant, and have a healthy baby.

• Check out these tips on healthy eating during pregnancy
• Ask your doctor or midwife if you need to take a daily prenatal supplement during pregnancy
• Take a daily supplement with 400 to 800 micrograms (mcg) of folic acid  — folic acid is a vitamin that can prevent birth defects

Gain weight in a healthy way.

Gaining a certain amount of weight during pregnancy is important for both you and your baby.  Learn how much weight is healthy for you to gain during pregnancy .

Even if you're overweight, you still need to gain some weight for your baby to grow. Ask your doctor or midwife how much weight is healthy for you to gain. 

Stay active. 

Being physically active can help you have a healthier pregnancy. Aim for at least 150 minutes a week of moderate-intensity aerobic activity — like walking, dancing, or swimming. 

If you haven’t been active before, start slow and do what you can! Even a 5-minute walk has real health benefits, and you can add more activity over time.

Get more information about physical activity during pregnancy from these resources:

• Stay Active During Pregnancy: Quick Tips
• Move Your Way: Pregnancy

Prevent Infections

Take steps to prevent infections..

Follow these tips to prevent infections and help keep your baby safe:

• Wash your hands often with soap and water
• Make safe food choices and prepare food safely
• If you have a cat, learn how to protect yourself from toxoplasmosis (a disease spread by dirty cat litter)
• Get vaccines to protect you from whooping cough and the flu
• Avoid traveling to an area with Zika virus — and if you have to travel to an area with Zika, learn how to protect yourself from Zika virus

Learn more about preventing infections during pregnancy .

Get Support and Plan Ahead

Ask for help if you need it..

Being pregnant may be tiring or stressful at times. Extra support from loved ones can help. For example, family members or friends can:

• Provide emotional support so you feel less stressed
• Visit the doctor or midwife with you
• Go with you to a breastfeeding or birthing class
• Change the litter box if you have a cat
• Help prepare for the baby’s arrival by setting up furniture

Think about what you need, and don’t be afraid to ask for help.

Plan ahead for the first year with your new baby.

Having a new baby is exciting, but it can be stressful. Take steps to help you prepare for your new baby:

• Create a safe sleeping area for your baby , without soft objects in the crib.
• Talk with your doctor or midwife about newborn screening tests .
• Learn how to breastfeed your baby .
• Know the signs and symptoms of postpartum depression . About 1 in 8 women experience depression after they have a baby. Talk to your doctor or midwife if you have any questions or concerns.
• Make sure to keep up with postpartum visits to your doctor or midwife.
• Talk to friends and family about helping out after the baby arrives. If you don't want visitors, people can support you in other ways, like dropping off food.

Read more about preparing for your baby .

Before You Get Pregnant

Not pregnant yet plan ahead..

Planning ahead can help you have a healthier pregnancy. For example: 

• Take a daily supplement with 400 to 800 micrograms (mcg) of folic acid .  Taking folic acid before and during early pregnancy can help prevent certain birth defects. Most multivitamins have 400 mcg of folic acid — check the label to be sure.
• Stop drinking alcohol when you start trying to get pregnant .
• If you smoke, quit smoking when you start trying to get pregnant .

Read about more things you can do to plan ahead.

Schedule an appointment with a doctor or midwife.

• Get your blood pressure checked . If you have high blood pressure, ask your doctor how you can control it before and during your pregnancy.
• If you have a chronic (long-term) health condition, like diabetes, ask your doctor how you can control it before and during your pregnancy.
• Ask about getting vaccines before you get pregnant .
• Talk with your doctor about your family health history , including any medical conditions you have that could affect a pregnancy.
• Talk with your doctor about your risk for depression during pregnancy and whether you need counseling to help prevent it.  Learn about depression during and after pregnancy .
• Talk with your doctor about any medicines you’re taking — both prescription drugs and over-the-counter medicines. Some medicines may not be safe to take while you’re pregnant.
• If you take opioid pain medicine, talk with your doctor about how to protect yourself and your baby. Learn more about opioids and pregnancy .

Content last updated August 16, 2024

Reviewer Information

This information on healthy pregnancy was adapted from materials from the Centers for Disease Control and Prevention, the Eunice Kennedy Shriver National Institute on Child Health and Human Development, and the Office on Women’s Health.

Reviewed by: Heather Hamner, Ph.D., M.S., M.P.H. Division of Nutrition, Physical Activity, and Obesity National Center for Chronic Disease Prevention and Health Promotion Centers for Disease Control and Prevention

Valerie Levy, M.P.H. Public Health Advisor National Center for Chronic Disease Prevention and Health Promotion Centers for Disease Control and Prevention

August 2021

You may also be interested in:

Get Vaccines to Protect Your Health (Adults Ages 19 to 49 Years)

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A guide to your nhs antenatal appointments.

You’ll have a number of antenatal appointments during your pregnancy, and you’ll see a midwife or sometimes an obstetrician (doctor specialising in pregnancy). Here we have created a guide on the standard Antenatal appointments in the UK, please note that some pregnancies require extra Antenatal appointments. If you’re pregnant with your first baby, you’ll have more appointments than those already with children.

Your First Contact With A Midwife/GP

You should always contact a GP or midwife as soon as possible after you find out that you’re pregnant. It’s best to see your midwife or doctor as early as possible to get the information you need to have a healthy pregnancy.

They should give you information about:

• folic acid supplements.
• nutrition, diet and food hygiene.
• lifestyle factors – such as smoking, drinking and recreational drug use.
• antenatal screening tests.

It’s important to tell your midwife or doctor if: 

• there were any complications or infections in a previous pregnancy or delivery, such as pre-eclampsia or premature birth.
• you’re being treated for a long-term condition, such as diabetes or high blood pressure.
• you or anyone in your family has previously had a baby with a health condition (for example, spina bifida).
• there’s a family history of an inherited condition (for example, sickle cell or cystic fibrosis).
• you know that you’re a genetic carrier of an inherited condition such as sickle cell or thalassaemia – you should also tell the midwife if you know the baby’s biological father is a genetic carrier of these conditions.
• you have had  fertility treatment  and either a donor egg or donor sperm.

First Midwife Appointment (between 8-12 weeks)

Your first appointment will take around 1 hour . You will have the opportunity to talk about your pregnancy and for them to take some important tests. The midwife will ask questions about your health, your family’s health, and your preferences for your pregnancy. Your midwife or doctor should give you information about: 

• how the baby develops during pregnancy
• nutrition and diet
• exercise and pelvic floor exercises
• antenatal screening tests
• your antenatal care
• breastfeeding, including workshops
• antenatal education
• maternity benefits
• your options for where to have your baby

This appointment is an opportunity to tell your midwife or doctor if you’re in a vulnerable situation or if you need extra support.

8-14 Weeks Dating Scan

This is the ultrasound scan to give you an estimated due date, check the physical development of your baby, and screen for possible conditions, including Down’s syndrome. If you’d like to see baby before this point, firstScan offer early pregnancy scans from 6-15+6 weeks!

Early Scans

20 Week Scan

At this stage, you will be offered an ultrasound scan to check the physical development of your baby. This is also known as the  20-week scan . You can also find out the gender at this stage, but if you can’t wait that long, Window to the Womb offer early gender confirmation from 16-23 weeks!

Gender Scan + Fetal Well-being

25 Weeks Pregnant

You’ll have an appointment at 25 weeks if this is your first baby.

Your midwife or doctor should:

• use a tape measure to measure the size of your uterus.
• measure your blood pressure and test your urine for protein.

28 Weeks Pregnant

Your midwife or doctor should: 

• use a tape measure to measure the size of your uterus.
• offer more screening tests.
• consider an iron supplement if you’re anaemic.

34 Weeks Pregnant

Your midwife or doctor should give you information about preparing for labour and birth, including how to recognise active labour, ways of coping with pain in labour, and your birth plan.

• review, discuss and record the results of any screening tests from the last appointment.

Your midwife or doctor should give you information about caesarean section. This discussion may take place at the 34 week appointment, or at another time during your pregnancy.

They’ll discuss with you the reasons why a caesarean might be offered, what the procedure involves, the risks and benefits, and the implications for future pregnancies and births.

36 Weeks Pregnant

Your midwife or doctor should give you information about:

• breastfeeding
• caring for your newborn baby
• vitamin K and screening tests for your newborn baby
• your own health after your baby is born
• the “baby blues” and  postnatal depression

Your midwife or doctor will also:

• use a tape measure to measure the size of your uterus
• check the position of your baby
• measure your blood pressure and test your urine for protein

38 Weeks Pregnant

Your midwife or doctor will discuss the options and choices about what happens if your pregnancy lasts longer than 41 weeks.

40 Weeks Pregnant

You’ll have an appointment at 40 weeks if this is your first baby.

Your midwife or doctor should give you more information about what happens if your pregnancy lasts longer than 41 weeks.

41 Weeks Pregnant

• offer a membrane sweep
• discuss the options and choices for  induction of labour

If you have not had your baby by 42 weeks and have chosen not to have an induction, you should be offered increased monitoring of the baby.

If at any point you need extra reassurance, or want to see baby in 4D, at Window to the Womb, we are proud to offer our families an outstanding level of care throughout your pregnancy journey. Our clinics offer a range of private ultrasound scans from 6-42 weeks gestation, and are conducted by fully qualified, medical Sonographers. Our goal is to ensure you feel safe during your baby scan experience, which is why our staff undergo extensive training. Our clinic teams strive to offer you a first-class experience, and are always on-hand to answer any of your pregnancy questions.

https://www.nhs.uk/pregnancy/your-pregnancy-care/your-antenatal-appointments/

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Midwife or ob-gyn: Which is right for you?

While a midwife and an ob-gyn can both deliver babies, there are some differences between the two. Here's how to decide who's the right choice for you and your baby.

What's the difference between a midwife and an ob-gyn?

What to consider when choosing a midwife or an ob-gyn, midwife vs ob-gyn: what most people choose.

From the moment you read that positive pregnancy test , there are a million thoughts and questions racing through your head. One of the biggest questions you'll have to answer is: Who will provide your healthcare during your pregnancy and the birth of your baby?

You have a few options, including an obstetrician-gynecologist (ob-gyn) or a midwife .

Midwives and ob-gyns are both highly trained professionals who undergo many years of specialized education and training. But there are some differences between the two.

There are three types of midwives: certified nurse-midwives (who have nursing degrees, graduate degrees in nurse-midwifery, and midwifery certification), certified midwives (who aren't nurses but do have graduate degrees in midwifery, as well as certification), and certified professional midwives (who may not have post-graduate degrees, but specialize in midwifery and are certified).

Midwives can deliver babies outside of a hospital and are trained in alternative delivery methods like water birth , so they're a good choice if you want to deliver at a birthing center or at home .

Ob-gyns are medical doctors who specialize in women's health. They can also get additional certification from the American College of Obstetrics and Gynecology.

Ob-gyns are trained to handle more complicated pregnancies, like if you're high risk or carrying twins , or have a pre-existing medical condition. Ob-gyns are also surgeons and can perform cesarean sections if you need one or plan to have one.

Whether you choose a midwife or an ob-gyn will depend on a number of factors, including what kind of experience you want, where you plan to give birth, whether your pregnancy is high risk, and what your insurance will pay for . (The costs of childbirth with a midwife are on average less expensive than childbirth under the care of an obstetrician. But you'll want to check with your insurance to confirm what your out-of-pocket costs will be.)

"It's increasingly common for medical practices to employ both physicians and midwives, which ensures that pregnancy care can be collaborative between the two kinds of providers," says Kristin Cohen , DNP, a certified nurse-midwife and member of BabyCenter's Medical Advisory Board . "This way, you can receive the benefits of being cared for by both types of medical providers, if necessary."

If you already have a good relationship with a practitioner who provides prenatal care and delivers babies, you may want to stay right where you are.

But if you don't have a pregnancy care provider or your current provider isn't the right fit, here's what to consider when choosing between a midwife or an ob-gyn.

1. Do you have a serious, chronic medical condition?

If you have a pre-existing medical condition such as high blood pressure , epilepsy, heart disease, or diabetes , or had certain serious complications in a previous pregnancy, your pregnancy will probably be considered high risk. In this case, you'll need to see an obstetrician or possibly a maternal-fetal medicine specialist , also called a perinatologist (a physician who specializes in high-risk pregnancies).

If you start out with a midwife and develop a problem down the road – such as premature labor or preeclampsia – or find out that you're carrying twins or multiples, your midwife will likely recommend you see an obstetrician or perinatologist. Depending on your condition and your healthcare providers, you may be able to have a midwife and a physician handle your care together, if you want.

It's increasingly common for medical practices to employ both physicians and midwives, which ensures that pregnancy care can be collaborative between the two kinds of providers. - Kristin Cohen, DNP, certified nurse-midwife

2. How important to you is a holistic approach?

If you're looking for a practitioner who is more likely to take a holistic approach to your care – and to see pregnancy and birth as normal processes, intervening only when necessary and not routinely – you may prefer a midwife.

Births attended by midwives usually have fewer interventions – such as continuous electronic fetal monitoring , epidurals , and episiotomies – without any difference in outcomes for women or their babies. Women who opt for midwifery care tend to have a lower rate of cesarean section , too.

In general, midwives will pay close attention to any questions and concerns you have during your pregnancy, and will help you learn about the physical and emotional changes you experience throughout pregnancy. A midwife can also help you think about what kind of birth experience you want and help see it through.

That said, some physicians provide this kind of personalized care, too, and some midwives may not, so find out as much as you can about the practices in your community.

You can even consider interviewing midwives and doctors before making your final decision.

3. What kind of birth do you want?

If you have no health problems or pregnancy complications and you want to give birth in a birth center or at home, look for a midwife who practices in these settings.

Birthing centers, usually staffed by certified nurse-midwives, are known for being supportive environments for having a natural birth without routine interventions and for welcoming anyone you'd like to have there with you, including family, friends, and a doula if you have one.

If you want to give birth at home , you can choose a midwife to take care of you.

On the other hand, if you want the option of getting an epidural, or you're anxious about something going wrong during labor and delivery, you'll want to be in a hospital from the get-go. For a hospital birth, you can choose an ob-gyn or a midwife as your primary caregiver.

Obstetricians are by far the most common choice in the United States, though midwives are becoming more popular. Research has found Opens a new window that in recent years, licensed midwives attended 10.3% of deliveries in the United States.

The most important thing is to choose someone you feel completely comfortable with, who's appropriate for your individual needs, who'll respect your wishes, and who practices in the right setting for you.

"Whether you see a midwife or doctor during your pregnancy, this medical provider is your partner in helping you achieve the healthiest pregnancy possible," says Cohen. "Ideally, this relationship is based on mutual trust and respect. If you aren't happy with the care you're receiving, you can always find a different provider who is more aligned with what you're looking for in pregnancy and birth care."

Key Takeaways

• When it comes to pregnancy healthcare providers, you have a few options, including a midwife or an obstetrician-gynecologist (ob-gyn). Both types of provider are highly trained, highly educated experts.
• Ob-gyns are trained to handle high-risk pregnancies and other special circumstances, including if you're carrying twins or have a pre-existing condition. Ob-gyns can also perform c-sections.
• Midwives generally take a holistic approach to pregnancy, and typically intervene less often during childbirth.
• Ob-gyns are the most common choice in the U.S., attending almost 90% of deliveries.

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BabyCenter's editorial team is committed to providing the most helpful and trustworthy pregnancy and parenting information in the world. When creating and updating content, we rely on credible sources: respected health organizations, professional groups of doctors and other experts, and published studies in peer-reviewed journals. We believe you should always know the source of the information you're seeing. Learn more about our editorial and medical review policies .

ACNM. 2020. Core Competencies for Basic Midwifery Practice. American College of Nurse-Midwives. https://www.midwife.org/acnm/files/acnmlibrarydata/uploadfilename/000000000050/ACNMCoreCompetenciesMar2020_final.pdf Opens a new window [Accessed August 2024]

ACNM. 2014. Position Statement: Appropriate Use of Technology in Childbirth. American College of Nurse-Midwives. http://midwife.org/ACNM/files/ACNMLibraryData/UPLOADFILENAME/000000000054/Appropriate-Use-of-Technology-in-Childbirth-May-2014.pdf Opens a new window [Accessed August 2024]

Loewenberg Weisband Y, et al. 2018. Birth Outcomes of Women Using a Midwife versus Women Using a Physician for Prenatal Care. Journal of Midwifery and Women's Health 63(4):399-409. https://pubmed.ncbi.nlm.nih.gov/29944777/ Opens a new window [Accessed August 2024]

March of Dimes. 2022. Nowhere to Go: Maternity Care Deserts Across the U.S. https://www.marchofdimes.org/sites/default/files/2022-10/2022_Maternity_Care_Report.pdf Opens a new window [Accessed August 2024]

Osterman M, et al. 2022. Births: Final Data for 2022. National Vital Statistics Reports 73(2). https://www.cdc.gov/nchs/data/nvsr/nvsr73/nvsr73-02.pdf Opens a new window [Accessed August 2024]

Sutcliffe K, et al. 2012. Comparing midwife-led and doctor-led maternity care: a systematic review of reviews. Journal of Advanced Nursing 68(11): 2376-2386. https://onlinelibrary.wiley.com/doi/10.1111/j.1365-2648.2012.05998.x Opens a new window [Accessed August 2024]

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As soon as you think you might be pregnant, visit your doctor or midwife. Your health in the early weeks of your pregnancy is particularly important.

During your pregnancy, you'll have regular checkups. These prenatal visits can help you have a safe and healthy pregnancy. Your doctor or midwife is watching for problems that can be found through these office visits.

At different times in your pregnancy, you will have exams and tests. Some are routine. Others are done only when there is a chance of a problem.

Your body will go through many changes during each trimester of pregnancy. So rest when you need it, ask for help from friends and family, and eat well.

What changes can you expect in your body?

Pregnancy changes can be different for every person and every pregnancy. Some of the most common changes during the first 13 weeks include feeling tired, feeling sick to your stomach, and having tender breasts. It's also common to need to urinate more often.

As you move into your second trimester (weeks 14 to 27), you may start to look pregnant. You may notice some differences in how you feel. You might feel less sick to your stomach and have more energy. And you may not have to urinate as often.

The third trimester lasts from week 28 to the birth. You may have some discomfort during this time. You may feel tired and have discomfort in many parts of your body. You may have trouble breathing and problems getting comfortable so you can sleep.

How can you cope with changes in your emotions?

When you're pregnant, hormone changes can affect your emotions and how you feel. It's important to take care of yourself. Ask family and friends for support. Let them know how you're doing. Spend time doing things you enjoy, and find ways to manage stress. If you're overwhelmed, talk to your doctor or a counselor.

What can you do to have a healthy pregnancy?

Taking great care of yourself is the best thing you can do to have a healthy pregnancy. Everything healthy that you do helps.

They are an important part of a healthy pregnancy. Your doctor or midwife will weigh you and measure your belly. You'll also have tests to watch for problems that could occur.

Choose foods like fruits, vegetables, whole grains, lean proteins, low-fat dairy, and healthy fats.

Drink plenty of water before, during, and after you're active, especially when it's hot out.

Go to bed earlier than usual and get up later, if you can. Take naps, unless napping makes you sleepless at night.

This includes tobacco, vaping, marijuana and other drugs, alcohol, strong chemicals, radiation (like X-rays), and risky sports.

Health Tools

Health Tools help you make wise health decisions or take action to improve your health.

• Pregnancy and Diabetes: Planning for Pregnancy
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Prenatal Visits and Tests

Regular prenatal visits are very important during any pregnancy. These quick office visits may seem simple and routine. But they can help you have a safe and healthy pregnancy. Your doctor is watching for problems that can only be found through regular checkups. The visits also give you and your doctor time to build a good relationship.

After your first visit, you will most likely start on a schedule of monthly visits. In your third trimester, the visits will get more frequent. Based on your health, your age, and if you've had a normal, full-term pregnancy before, your doctor may want to see you more or less often.

At different times in your pregnancy, you will have exams and tests. Some are routine. Others are done only when there is a chance of a problem. Everything healthy you do for your body helps you have a healthy pregnancy. Rest when you need it. Eat well, drink plenty of water, and exercise regularly.

Your first prenatal visit

At your first prenatal visit, your doctor or midwife will ask about your medical history and figure out your due date. You'll have a complete physical exam. You may also have some tests. This will provide information that can be used to check for any problems as your pregnancy progresses.

First-trimester exams and tests

At each visit in your first trimester, you'll be weighed and have your blood pressure checked. You may also have a urine test. You can choose whether to have tests for birth defects. And your doctor or midwife may ask questions about your health and emotions.

Second-trimester exams and tests

At each visit in the second trimester, you'll be weighed and have your blood pressure checked. You may also have urine and blood tests. Your doctor or midwife will listen to your baby's heartbeat and track your baby's growth and position. And you may be asked about birth defect testing and how you feel emotionally.

Third-trimester exams and tests

At each visit in the third trimester, you'll be weighed, and your blood pressure and urine will be checked. Your doctor or midwife will track your baby's growth and position and see whether your baby is head-down. Your doctor may suggest other tests and ask how you feel emotionally.

• First-Trimester Exams and Tests
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Testing for Birth Defects

Birth defects testing may be done during pregnancy to look for possible problems with the baby. Birth defects include:

• Chromosome defects, such as Down syndrome and trisomy 18 .
• Diseases that can be passed down in families, such as Tay-Sachs disease and sickle cell disease .
• Problems with the structure of an organ, including heart defects and neural tube defects .

There are two types of birth defects tests.

These are blood tests and ultrasounds. These tests show the chance that a baby has certain birth defects.

These tests involve taking some of the baby's cells to look at the genes and chromosomes. They can show if a baby has certain birth defects.

Your doctor can tell you which tests are available and which ones might be best for you. You may want to talk with a genetic counselor, who can discuss the reasons to have or not have a test.

• Birth Defects Testing

Health and Nutrition

Taking care of yourself is the best thing you can do to have a healthy pregnancy. Get regular checkups, and eat a variety of healthy foods. Try to get regular exercise and plenty of rest. And avoid things that could be harmful, including smoking, vaping, drinking alcohol, and using marijuana or other drugs.

Get the nutrition you need

Your nutrition needs increase during pregnancy. Your body needs protein , carbohydrate , and fats for energy. Good sources of these nutrients include:

• Lean protein. Examples include fish that are low in mercury, poultry without skin, low-fat milk products, and beans and peas (legumes). Fish that are low in mercury include shrimp, salmon, and catfish.
• Carbohydrate from whole grains, fruits, vegetables, legumes (peas, beans, and lentils), and low-fat milk products.
• Unsaturated fats like olive oil and canola oil, nuts, and fish.

Important vitamins and minerals during pregnancy include:

Calcium is found in dairy products and nonmilk sources such as tofu, broccoli, fortified orange juice or soy milk, and greens.

Folic acid (or folate) is found in foods such as liver, vegetables (especially spinach, asparagus, and brussels sprouts), fruits (such as bananas and oranges), and beans and peas. Enriched products such as cereal, bread, pasta, and rice are also good sources.

Iron is found in foods such as red meat, shellfish, poultry, eggs, nuts, beans, raisins, whole-grain bread, and leafy green vegetables.

Even if you have good eating habits, your doctor may suggest a multivitamin to make sure you get enough iron and folic acid.

Exercise is good for you during a healthy pregnancy. It can help relieve back pain, swelling, and other discomforts. Exercise also prepares your muscles for childbirth. And it can improve your energy level and help you sleep better.

Activities that are recommended include:

• Moderate exercise such as brisk walking or swimming. Try to do at least 2½ hours of moderate activity a week. One way to do this is to be active 30 minutes a day, at least 5 days a week. It's fine to be active in shorter periods of time throughout your day and week that add up to the recommended goals.
• Stretching and strengthening exercises, such as forward bends and pelvic tilts. Try a prenatal exercise class, such as prenatal yoga. Avoid hot yoga, such as Bikram yoga. It may make your body temperature too high.
• Kegel exercises. These exercises strengthen your pelvic floor muscles . They may help prevent urine leaks (incontinence) after childbirth.

Moderate exercise is safe for most pregnancies. But if you don't already exercise, be sure to talk with your doctor before you start a new exercise program.

If you exercised before getting pregnant, you should be able to stay with your same routine early in your pregnancy. Later in your pregnancy, you may want to switch to more gentle activities.

• Exercise During Pregnancy
• Kegel Exercises
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• Pregnancy: Healthy Weight Gain
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• Quick Tips: Healthy Pregnancy Habits

Dos and Don'ts of Pregnancy

What things to avoid when you're pregnant.

When you're pregnant, there's a lot to learn about what's safe and what to avoid. Some things to try to avoid include:

• These include shark, swordfish, king mackerel, marlin, orange roughy, and bigeye tuna, as well as tilefish from the Gulf of Mexico.
• It's okay to eat up to 8 to 12 ounces a week of fish that are low in mercury or up to 4 ounces a week of fish that have medium levels of mercury. Some fish that are low in mercury are salmon, shrimp, canned light tuna, cod, and tilapia. Some fish that have medium levels of mercury are halibut and white albacore tuna.
• For more advice about eating fish, you can visit the U.S. Food and Drug Administration (FDA) or U.S. Environmental Protection Agency (EPA) website.
• Raw (unpasteurized) milk and cheeses made with raw milk. Cheeses usually made with unpasteurized milk include feta, Brie, Camembert, blue cheeses, and Mexican-style cheeses such as queso blanco.
• Alcohol and drugs. If you use alcohol, marijuana, or other drugs, quit or cut back as much as you can. It's safest not to use them at all. Talk to your doctor if you need help to quit.
• Limit caffeine to about 200 to 300 mg per day. On average a cup of brewed coffee has around 80 to 100 mg of caffeine.
• Be aware that many soft drinks, energy drinks, and chocolate have caffeine.
• Tobacco smoke and vaping. They contain harmful chemicals such as nicotine and carbon monoxide. Talk to your doctor if you need help quitting.
• Things that can make your body too hot, such as hot tubs or saunas. High body temperature can be harmful. Talk with your doctor before using them. Your doctor can tell you if it's safe.
• Risky activities. These include things like horseback or motorcycle riding, water-skiing, scuba diving, and exercising at a high altitude (above 6,000 feet). If you live in a place with a high altitude, talk to your doctor about how you can exercise safely.
• Raw or undercooked meat or seafood.
• Unpasteurized juice and milk.
• Soft cheese and cheese made with unpasteurized milk.
• Premade deli salads such as egg, pasta, and chicken salad.
• Hot dogs and deli meats that haven't been heated to steaming.
• Raw sprouts.
• Undercooked eggs.
• Unwashed fresh fruits and vegetables.
• Cat poop, cat litter, or outdoor soil that cats use. These things can cause an infection that could be harmful.
• Medicines that are not approved by your doctor or midwife. These include over-the-counter medicines, vitamins, and supplements.
• Strong chemicals include pesticides, household cleaners, and paint.
• Make changes at work or home to avoid these substances. If you can't, wear personal protective equipment (PPE) such as a mask, gloves, and goggles.

What's okay when you're pregnant

Going to work or school while pregnant is usually safe. If you aren't having any problems with your pregnancy, you can probably keep going until you go into labor. But if you have to be very active or do things like stand or walk a lot, talk with your doctor or midwife.

Having sex during pregnancy is okay, unless your doctor tells you not to. But how sexy you feel may be a bit different than in the past. Pregnancy may be a chance to explore new ways to feel close, new sexual positions, and new ways to communicate.

Travel during pregnancy generally is safe if you're healthy and not at risk for problems. The safest time to travel is between 14 and 28 weeks, when your risks for miscarriage and early labor are lowest. Check with your doctor before you travel.

• Acetaminophen Use During Pregnancy
• Alcohol or Drug Use During Pregnancy
• Avoiding Mercury in Fish
• Food Poisoning During Pregnancy
• Medicines During Pregnancy
• Pregnancy: Chemicals, Cosmetics, and Radiation
• Pregnancy: Hot Tub and Sauna Use
• Pregnancy: Work and School Issues
• Quitting Smoking or Vaping During Pregnancy
• Sex During Pregnancy
• Travel During Pregnancy

Body Changes

Your body will go through a lot during pregnancy. Common changes include tiredness, sleep problems, swelling or tender breasts, and back pain. Other changes include hemorrhoids, constipation, changes in vaginal discharge, and swelling of your feet and ankles.

First trimester changes

Pregnancy changes can be different for every person and every pregnancy.

Here are some things you might notice during the first 13 weeks.

• You may feel tired or need naps during the day. Give yourself permission to rest.
• You may crave certain foods, need to avoid certain foods, or just feel sick to your stomach. All of these things are common. Feeling sick to your stomach is sometimes called morning sickness.
• Your breasts may feel different. They may feel tender or get bigger. And your nipples may get darker. You may need a more supportive bra.
• You may need to urinate more. Your growing uterus and changing hormones can affect your bladder as soon as the first trimester.
• You may feel a fullness or aching in your lower belly. This can feel like the kind of cramps you might get before a period.
• You may have skin changes. You may get dark patches on your face (melasma). Or you might have reddish or itchy palms, acne, or more noticeable veins.
• You may not sleep well at night, even in early pregnancy. New hormones and lots of body changes may make it hard to get good sleep.
• You may feel emotional. Fear, anxiety, excitement, or not feeling strongly about anything are all normal.
• Your hair may be thicker. New hormones may slow hair loss and increase hair growth.

Second trimester changes

During your second trimester, you may start to look pregnant. And you may notice changes in how you feel. For example, you may feel less sick to your stomach and have more energy. And you might not have to urinate as much.

Here are some other things you may notice during weeks 14 to 27:

• Breast changes. Your breasts may get bigger, and your nipples may get darker. And the veins in your chest may show more. If you notice discharge from your nipples, it means your body is doing what it should—preparing to make breast milk.
• Aches and pains. You may have leg cramps or pain in your back, pelvis, or hips. You may also feel pain on either side of your belly that may go down into your groin. This is called round ligament pain. It happens because your growing belly is stretching the ligaments that support your uterus.
• Dark or discolored areas. You may get tiny reddish, purplish, or dark areas on your face, neck, arms, or chest. Or you may notice dark patches on your face. They usually go away after pregnancy.
• Stretch marks. These may appear on your breasts, belly, or thighs. Stretch marks don't go away, but they usually fade.
• Linea nigra. This is the term for a dark line from your belly button to your pubic area. It's normal and will also fade after pregnancy.
• Itchy skin. Your belly may itch the most because it's stretching so much. Try using a moisturizer.
• Hemorrhoids and constipation . This is common. Medicines can help. Drinking enough fluids and adding fiber to your diet can also help.
• Heartburn. You can try medicines and making a few changes in the way you eat.
• Stuffiness, nosebleeds, and sensitive gums. The extra blood you're making can cause your mucous membranes to swell or bleed. Saline drops or a saline rinse can help with a stuffy nose. And a softer toothbrush can help with bleeding gums.
• Numbness, pain, and weakness in your hands. This is usually caused by carpal tunnel syndrome and will go away after pregnancy. In the meantime, wearing splints might help.
• Braxton Hicks contractions. These are "warm-up" contractions. They don't thin and open the cervix, so they don't lead to labor.

Third trimester changes

The third trimester lasts from week 28 to the birth. You may have some discomfort during this time as your belly gets bigger. You may have trouble breathing. Your uterus is now just below your rib cage, so your lungs have less room to expand. And you might have aches and pains.

You might have trouble getting comfortable so you can sleep. Later in pregnancy, it's best to lie on your left side. Lying on your back interferes with blood circulation, and lying on your stomach isn't possible. And when you lie on your right side or on your back, the weight of your uterus can partly block the large blood vessel in front of your backbone.

Symptoms that are common in the third trimester include:

• Braxton Hicks contractions, which are "warm-up" contractions. They don't thin and open the cervix, so they don't lead to labor.
• Fatigue (tiredness).
• Back pain, pelvic ache, and hip pain.
• Hemorrhoids and constipation.
• Heartburn .
• Hand pain, numbness, and weakness, usually caused by carpal tunnel syndrome .
• Mild swelling (edema) of the feet and ankles.
• A need to urinate often. This is caused by your enlarged uterus and the pressure of the baby's head on your bladder.
• Back Pain During Pregnancy
• Braxton Hicks Contractions
• Breast Changes During Pregnancy
• Early Signs of Pregnancy
• Fatigue During Pregnancy
• Heartburn During Pregnancy
• Leg Cramps During Pregnancy
• Managing Emotional Changes During Pregnancy
• Pregnancy: Carpal Tunnel Syndrome
• Pregnancy: Changes in Bowel Habits
• Pregnancy: Hair Changes
• Pregnancy: Hemorrhoids and Constipation
• Pregnancy: Nosebleeds and Bleeding Gums
• Pregnancy: Pelvic and Hip Pain
• Pregnancy: Stretch Marks, Itching, and Skin Changes
• Pregnancy: Varicose Veins
• Sleep Problems During Pregnancy
• Swelling During Pregnancy

Stages of Pregnancy

Pregnancy is measured in trimesters, starting on the first day of your last menstrual period and totaling 40 weeks. Most babies are born at 37 to 42 weeks.

• The first trimester of pregnancy is weeks 1 through 13.
• The second trimester is weeks 14 to 27.
• The third trimester is weeks 28 to birth.

A lot of changes happen each week as the pregnancy develops and grows from embryo to fetus to the birth of a baby.

First trimester

Even though you can't feel it, there's a lot happening during the first 13 weeks of pregnancy .

• At 6 weeks, an embryo has the beginnings of a brain, eyes, ears, heart, lungs, and liver. There are tiny bumps where arms and legs will grow.
• At 8 weeks, it has webbed fingers and arms that bend. The muscles are almost working. And the brain and heart are developing.
• At 11 weeks, the embryo is now called a fetus . At this point, the fetus has most of the body structures that you have.
• At 12 weeks, it can move its head, jaw, and tongue. And it has eyelids and fingernails too.

Second trimester

Weeks 14 to 27 bring growth you can actually see and feel.

Here are some things that happen during the second trimester:

• Your baby is growing quickly and will weigh about 1 to 2 pounds.
• You may start to feel your baby move sometime between weeks 16 and 22.
• Your baby may now respond to your voice or touch.
• Your baby may be thumb-sucking, rolling, and kicking.
• If you feel jerky movements, your baby may have hiccups. They can last as long as an hour.
• You may notice more baby movements at night.
• Your baby's eyes move a lot now.
• Your baby's lungs are getting stronger and ready to breathe.
• Your baby's organs are developing. An ultrasound may reveal the sex—if you want to know.

Third trimester

The third trimester of pregnancy spans from week 28 to the birth. Here is what happens during this time:

• Your baby grows larger, putting on a lot of weight.
• You'll notice more movement or less movement at certain times of the day and night. Babies move often, especially between the 27th and 32nd weeks. After week 32, babies may seem to move less because they are too big to move around easily inside the uterus.
• Your baby's eyes can respond to changes in light.
• Your baby's skin is smooth. And their arms and legs look chubby.
• Your baby's lungs and other organs mature.

At the end of the third trimester, a baby's head will usually settle into a head-down position for delivery.

• How Pregnancy (Conception) Occurs
• Week 8 of Pregnancy: What's Going On Inside
• Week 12 of Pregnancy: What's Going On Inside
• Week 16 of Pregnancy: What's Going On Inside
• Week 20 of Pregnancy: What's Going On Inside
• Week 24 of Pregnancy: What's Going On Inside
• Week 28 of Pregnancy: What's Going On Inside
• Week 32 of Pregnancy: What's Going On Inside
• Week 36 of Pregnancy: What's Going On Inside
• Week 40 of Pregnancy: What's Going On Inside
• Your Baby's Movements During Pregnancy

Emotions and Relationships

Being pregnant can be an exciting time. But it can also be a stressful and emotional time. There's a lot you need to think about and plan for, which can be overwhelming. You may notice your moods changing often. And when you're pregnant, your body goes through lots of hormone changes, which can affect your emotions and how you feel.

It's important to take care of your body—and your emotions—during pregnancy. So don't hesitate to ask friends and family for support.

Check in often with your partner, close friends, or loved ones. Let them know how you're doing. What are your biggest fears? What makes you the most stressed? How can they help?

Take time for yourself every day. Watch a favorite movie. Go for walks with a friend. Or find some time for your favorite hobby.

Make time for a stress-relieving activity each day. Find what works best for you. Maybe you'd like to try yoga, meditation, or guided imagery.

It may help to write down your fears about having a baby or becoming a parent. Share this with someone you trust. Decide which worries are actually small, and try to let them go.

If you feel overwhelmed, talk to your doctor or a counselor. Consider joining a support group for pregnant women or new moms.

Getting support from your partner

Pregnancy can present many changes and unknowns. When both partners support each other, they strengthen their bond and their sense of teamwork. The stronger your relationship with your partner is now, the better prepared you'll be to parent together.

Try these tips for bonding with your partner.

Try to simply listen, rather than fix or judge. Pregnancy is a different experience, so expect new feelings.

Ask questions and give each other support.

They may find great advice, tips, and support online or from others who've "been there."

Go for walks, play a game, or watch a movie. Hug and hold hands.

Maybe you both could cut back on caffeine or fried foods, for example?

• Massage Therapy During Pregnancy
• Partner Support During Pregnancy
• Stress Management

Health Concerns

Some health problems or concerns come up before someone is pregnant. Other times, problems may come up during pregnancy. Your doctor or midwife will work with you to prevent or manage these problems to help you have a healthy pregnancy.

If you have a health problem or concern, you may have a high-risk pregnancy. This means that your doctor or midwife needs to follow you closely. It doesn't mean that something will go wrong during your pregnancy.

Things that can make a pregnancy high-risk

Many things can make a pregnancy high-risk. Here are some general risk factors.

Your pregnancy is high-risk if you have:

• Diabetes, cancer, high blood pressure, kidney disease, or epilepsy.
• An infection, such as HIV or hepatitis C. Other infections that can cause a problem include COVID-19, cytomegalovirus (CMV), chickenpox, rubella, toxoplasmosis, and syphilis.
• A health problem such as a heart valve problem, sickle cell disease, asthma, lupus, or rheumatoid arthritis.

Your pregnancy is high-risk if you are either:

• Younger than 17.
• 35 or older.

Your pregnancy is high-risk if you:

• Smoke or vape, drink alcohol, or use marijuana or other drugs.
• Take certain medicines, like lithium, phenytoin (Dilantin), valproic acid (Depakene), or carbamazepine (such as Tegretol).

These include a history of:

• Three or more miscarriages.
• A problem such as preterm labor, preeclampsia, or seizures (eclampsia).

This includes:

• Carrying more than one baby (multiple pregnancy).
• Being pregnant with a baby who has a genetic condition, such as Down syndrome, or a heart, lung, or kidney problem.
• Anemia During Pregnancy
• Antiphospholipid Syndrome and Pregnancy
• Asthma During Pregnancy
• Bed Rest in Pregnancy
• Cancer During Pregnancy
• Depression During Pregnancy
• Ectopic Pregnancy
• Gestational Diabetes
• High Blood Pressure During Pregnancy
• High-Risk Pregnancy
• HIV and Pregnancy
• Immunizations and Pregnancy
• Lupus and Pregnancy
• Molar Pregnancy
• Multiple Pregnancy: Twins or More
• Obesity and Pregnancy
• Post-Term Pregnancy
• Preeclampsia
• Pregnancy After Age 35
• Pregnancy After Weight-Loss (Bariatric) Surgery
• Pregnancy and Chronic High Blood Pressure
• Pregnancy and Epilepsy
• Preterm Labor
• Toxoplasmosis During Pregnancy
• Vaginal Yeast Infection During Pregnancy

Planning for Labor

As your baby's birth gets closer, you can still take steps that will help you have a healthy labor and birth. For example, you can take classes to help you prepare for the birth. Talk to your doctor ahead of time about what you would like to happen during your labor.

A birth plan lets you write down your vision of an ideal birth and share it with your support person, the hospital or birth center, and your doctor or midwife.

Your birth may not go as planned. But the process of making a plan can be a great way to get everyone on the same page about what you think you'd prefer.

Here are some ideas for making a birth plan.

It could be a hospital, a birthing center, or your home. The setting may depend on your level of risk for problems during delivery, and if you're working with a doctor or midwife.

Think breathing techniques, laboring in water, or trying different positions.

Think about pain medicine you'd want, even if you don't think you'll need it. And think about your options if you end up needing a C-section.

• You might want your baby to stay in the room with you rather than in the nursery.
• You might want to delay some tests so you can hold your baby and start breastfeeding right away.

Maybe you want family and friends in the room, or maybe you only want the baby's other parent or a support person like a doula.

As you think about your plan, give yourself permission to be flexible. It's hard to know what will happen. The most important thing is to make sure you and your baby are healthy and safe.

• Childbirth Classes
• Labor and Delivery
• My Birth Plan
• Pregnancy: Deciding Where to Deliver

When to Call a Doctor

At any time during pregnancy.

At any time during your pregnancy, call 911 if you think you have symptoms of a blood clot in your lung (called a pulmonary embolism). These may include:

• Sudden chest pain.
• Trouble breathing.
• Coughing up blood.

At any time during your pregnancy, call your doctor now or seek immediate medical care if you:

• Sudden swelling of your face, hands, or feet.
• Visual problems (such as dimness or blurring).
• Severe headache.
• Pain in the arm, calf, back of the knee, thigh, or groin.
• Redness and swelling in the arm, leg, or groin.

At any time during your pregnancy, call your doctor or midwife now if you:

• Have pain, cramping, or fever with bleeding from the vagina.
• Pass some tissue from the uterus.
• Think or know you have a fever.
• Vomit more than 3 times a day or are too nauseated to eat or drink, especially if you also have fever or pain.
• Have an increase or gush of fluid from your vagina. It's possible to mistake a leak of amniotic fluid for a problem with bladder control.

At any time during your pregnancy, call your doctor or midwife today if you:

• Notice increased swelling of your face, hands, or feet.
• Have any vaginal bleeding or an increase in your usual amount of vaginal discharge.
• Have pelvic pain that doesn't get better or go away.
• Your itching gets worse or you get other symptoms.
• There is a new or increasing yellow color to your skin or the whites of your eyes.
• Have painful or frequent urination or urine that is cloudy, foul-smelling, or bloody.
• Feel unusually weak.

Between 20 and 37 weeks

If you are between 20 and 37 weeks pregnant, call 911 or other emergency services immediately if you:

• Have severe vaginal bleeding.
• Have severe abdominal (belly) pain.
• Are in your third trimester and have had fluid gushing or leaking from your vagina (the amniotic sac has ruptured) AND you know or think the umbilical cord is bulging into your vagina (cord prolapse). If this happens, immediately get down on your knees so your buttocks are higher than your head to decrease pressure on the cord until help arrives. Cord prolapse can cut off the fetus's blood supply. (These measures apply to you if you are as early as 24 weeks pregnant.)

If you are between 20 and 37 weeks pregnant, call your doctor or midwife now or go to the hospital if you:

• Mild or menstrual-like cramping with or without diarrhea.
• Regular contractions for an hour. This means about 6 or more contractions in 1 hour, even after you've had a glass of water and are resting.
• Unexplained low back pain or pelvic pressure.
• Have noticed that your baby has stopped moving or is moving much less than normal.
• Have uterine tenderness or unexplained fever (possible symptoms of infection).

After 37 weeks

After 37 weeks, call 911 or other emergency services immediately if you:

• Have had fluid gushing or leaking from your vagina (the amniotic sac has ruptured) AND you know or think the umbilical cord is bulging into your vagina (cord prolapse). If this happens, immediately get down on your knees so your buttocks are higher than your head to decrease pressure on the cord until help arrives. Cord prolapse can cut off the fetus's blood supply. (These measures apply to you if you are as early as 24 weeks pregnant.)

After 37 weeks of pregnancy, call your doctor or midwife now or go the hospital if you:

• Have vaginal bleeding. (For light spotting, you can call at any time on the same day.)
• Have had regular contractions for an hour. This means about 4 or more in 20 minutes, or about 8 or more within 1 hour.
• Have a sudden release of fluid from the vagina.
• Notice that the baby has stopped moving or is moving much less than normal.

Check your symptoms

• Pregnancy-Related Problems

Current as of: July 10, 2023

Author: Healthwise Staff

Clinical Review Board All Healthwise education is reviewed by a team that includes physicians, nurses, advanced practitioners, registered dieticians, and other healthcare professionals.

This information does not replace the advice of a doctor. Healthwise, Incorporated, disclaims any warranty or liability for your use of this information. Your use of this information means that you agree to the Terms of Use . Learn how we develop our content .

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Women want to see the same health provider during pregnancy, birth and beyond: Study

I n theory, pregnant women in Australia can choose the type of health provider they see during pregnancy, labor and after they give birth. But this is often dependent on where you live and how much you can afford in out-of-pocket costs.

While standard public hospital care is the most common in Australia, accounting for 40.9% of births, the other main options are:

• GP shared care, where the woman sees her GP for some appointments (15% of births)
• midwifery continuity of care in the public system, often called midwifery group practice or caseload care, where the woman sees the same midwife of team of midwives (14%)
• private obstetrician care (10.6%)
• private midwifery care (1.9%).

Given the choice, which model would women prefer?

Our new research , published BMC Pregnancy and Childbirth , found women favored seeing the same health provider throughout pregnancy, in labor and after they have their baby—whether that's via midwifery group practice, a private midwife or a private obstetrician.

Assessing strengths and limitations

We surveyed 8,804 Australian women for the Birth Experience Study (BESt) and 2,909 provided additional comments about their model of maternity care. The respondents were representative of state and territory population breakdowns, however fewer respondents were First Nations or from culturally or linguistically diverse backgrounds.

We analyzed these comments in six categories—standard maternity care, high-risk maternity care, GP shared care, midwifery group practice, private obstetric care and private midwifery care—based on the perceived strengths and limitations for each model of care.

Overall, we found models of care that were fragmented and didn't provide continuity through the pregnancy, birth and postnatal period (standard care, high risk care and GP shared care) were more likely to be described negatively, with more comments about limitations than strengths.

What women thought of standard maternity care in hospitals

Women who experienced standard maternity care, where they saw many different health care providers, were disappointed about having to retell their story at every appointment and said they would have preferred continuity of midwifery care.

Positive comments about this model of care were often about a midwife or doctor who went above and beyond and gave extra care within the constraints of a fragmented system.

The model of care with the highest number of comments about limitations was high-risk maternity care. For women with pregnancy complications who have their baby in the public system, this means seeing different doctors on different days.

Some respondents received conflicting advice from different doctors, and said the focus was on their complications instead of their pregnancy journey. One woman in high-risk care noted:

"The experience was very impersonal, their focus was my cervix, not preparing me for birth."

Why women favored continuity of care

Overall, there were more positive comments about models of care that provided continuity of care: private midwifery care, private obstetric care and midwifery group practice in public hospitals.

Women recognized the benefits of continuity and how this included informed decision-making and supported their choices.

The model of care with the highest number of positive comments was care from a privately practicing midwife. Women felt they received the "gold standard of maternity care" when they had this model. One woman described her care as:

"Extremely personable! Home visits were like having tea with a friend but very professional. Her knowledge and empathy made me feel safe and protected. She respected all of my decisions. She reminded me often that I didn't need her help when it came to birthing my child, but she was there if I wanted it (or did need it)."

However, this is a private model of care and women need to pay for it. So there are barriers in accessing this model of care due to the cost and the small numbers working in Australia, particularly in regional, rural and remote areas , among other barriers.

Women who had private obstetricians were also positive about their care, especially among women with medical or pregnancy complications—this type of care had the second-highest number of positive comments.

This was followed by women who had continuity of care from midwives in the public system, which was described as respectful and supportive.

However, one of the limitations about continuity models of care is when the woman doesn't feel connected to her midwife or doctor. Some women who experienced this wished they had the opportunity to choose a different midwife or doctor.

What about shared care with a GP?

While shared care between the GP and hospital model of care is widely promoted in the public maternity care system as providing continuity, it had a similar number of negative comments to those who had fragmented standard hospital care.

Considering there is strong evidence about the benefits of midwifery continuity of care , and this model of care appears to be most acceptable to women, it's time to expand access so all Australian women can access continuity of care, regardless of their location or ability to pay.

More information: Helen Pelak et al, A content analysis of women's experiences of different models of maternity care: the Birth Experience Study (BESt), BMC Pregnancy and Childbirth (2023). DOI: 10.1186/s12884-023-06130-2

This article is republished from The Conversation under a Creative Commons license. Read the original article .

Provided by The Conversation

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• Open access
• Published: 14 August 2024

How to improve newborn outcomes in 60 s—delay clamping the umbilical cord

• Kranti C. Rumalla 1 ,
• Leslie Hansen-Lindner 2 ,
• Christi M. Walsh 1 &
• Martin A. Makary 1 , 3  

BMC Pregnancy and Childbirth volume  24 , Article number:  534 ( 2024 ) Cite this article

113 Accesses

Metrics details

Deferred umbilical cord clamping (DCC) has been employed with wide variation in the United States over the last few decades. This practice has the potential to improve infant health and outcomes at the population health level. Education campaigns and policy interventions can promote DCC use in a safe manner.

Peer Review reports

Introduction

Despite rapidly-developing evidence that deferred umbilical cord clamping (DCC) improves newborn outcomes, there is wide variation around this practice for the nearly 4 million births in the U.S. each year [ 1 , 2 ]. Given that the U.S. ranked 33 out of 38 OECD countries for infant mortality in 2019 with 5.7 deaths per 1,000 live births, the need for better perinatal care is pressing [ 1 ]. Broader adoption of deferred cord clamping represents one important quality improvement opportunity to improve newborn cardiovascular, neurological, and endocrine outcomes. This commentary summarizes the recent history of DCC implementation, the benefits and risk of DCC, and provides recommendations for increased adoption in the United States.

Assessment of Benefit and Risk

In the modern medical era, it became common practice to clamp and cut the umbilical cord shortly after the birth of a newborn. However, a growing body of evidence has established benefits to DCC [ 1 ]. It is a simple and free intervention that allows for the autotransfusion of placental blood before clamping [ 1 ]. The practice is endorsed by the American College of Obstetrics and Gynecologists (ACOG), American Academy of Pediatrics (AAP), Neonatal Resuscitation Program (NRP), and World Health Organization (WHO) [ 2 ]. There is wide variation in the use of DCC with a lack of standardized treatment protocols [ 2 ]. Based on well-designed randomized clinical trials and clinical wisdom, the implementation of standardized DCC protocols would provide both short- and long-term health benefits.

The first randomized-controlled trial performed in 1988 supported an acute benefit of DCC. There was a decreased likelihood of periventricular-intraventricular hemorrhage (IVH) [ 1 ]. Since then, trials have indicated many incremental health benefits, such as increased neonate hemoglobin levels. Lower transfusion rates improve outcomes and decrease the cost of care [ 3 ].

The benefits of DCC are more pronounced and evident in preterm births, such as a reduction in intraventricular hemorrhage (IVH) and overall increases in blood flow, stroke volume, and cardiac output [ 1 ].

While there are numerous acute health benefits with DCC, until recently literature was unclear about long-term benefits. One trial found modest neurodevelopment improvements 4 years post-birth [ 4 ]. Infants with the intervention had better fine motor functions compared to an immediate cord clamping group [ 4 ]. Most benefits start at the one-minute mark and diminish after three minutes [ 5 ]. To this day, no universal guidelines exist on the timing of delay. For instance, the WHO utilizes a 60-second threshold for DCC, while ACOG recommends 30–60 s [ 2 , 6 ].

The 2012 ACOG Committee Opinion popularized DCC in the United States. Prior to this, surveys estimate that less than 4% of obstetricians had a DCC policy at their hospital. By 2016, the percentage rose to 28.1% [ 2 ]. After the 2017 ACOG committee publication, this metric further rose to 85.5% by 2019 [ 2 ]. The threshold for DCC in all surveys was greater than 60 s. The dissemination of hospital policy correlates with increases in the use of DCC, but not always in a proportional manner [ 2 ]. There is a gap between the prevalence of hospital policy and obstetrician practice [ 3 ]. Public education campaigns facilitate patients’ ability to advocate for beneficial interventions prior to birth.

Obstetricians and other participating clinicians are more likely to perform DCC on preterm infants [ 2 ]. This is due to initial ACOG recommendations that stressed the importance of DCC in preterm infants. The pattern of increase is aligned with the evidence and literature at the time, highlighting the capacity for large-scale incremental physician practice change. European studies found that interdisciplinary guideline development and communication between policymakers, hospital administration, and physicians were vital in increasing DCC rates [ 2 ]. Recommendation adherence is better achieved through collaboration and physician involvement rather than top-down, zero-input methods.

Recommendations

The literature shows a wide variation in the use of deferred cord clamping in the United States. With proper informed consent and decision-making, DCC should be a standard and common practice during most births. Although a majority of hospitals have a DCC policy, thousands of infants do not receive it every year [ 7 ]. Resistance to changing clinical wisdom is common for physicians and patients alike. A multilateral patient and physician campaign is required to create large-scale practice pattern change.

Public health education is a necessary component to increasing the use of DCC. The CDC currently collects data on most U.S. hospitals via the Maternity Practices in Infant Nutrition and Care (mPINC) assessment. The 2022 mPINC survey includes a question referring to DCC, “How many healthy newborns at your hospital have their umbilical cord clamped more than one minute after birth?” [ 8 ]. While the CDC has been collecting this data for at least 4 years, results by hospital are not available for patients. Instead, hospital ratings organizations, such as the Leapfrog Group, should add DCC to their online, public data release. Armed with this information, parents can choose hospitals where DCC is a regular practice. Patients, however, may face challenges in selecting hospitals that consistently implement DCC, underscoring the importance of nationwide DCC adoption. In hospitals that do offer DCC, clinicians should explain the benefits and risks of DCC in a shared decision-making process.

The implementation of DCC requires changes to physician education. A qualitative study of provider input found five drivers of change: trusting colleagues, believing the evidence, honoring families, achieving personal certainty, and preserving the integrity of the parents and baby [ 7 ]. The most prevalent driver, trusting colleagues, had three caveats: colleagues as sources of information, watching a colleague’s practice, and colleagues as experts sharing their research [ 7 ]. This can be achieved on the hospital system level but also through professional societies, research conferences, and peer-review publications. Physician collaboration and involvement in the development of policies is essential. The use of federal and state policy is better positioned as a secondary arbitration to close the last marginal gaps in DCC use.

It is important to continue DCC and further expand vital maternity care practice in all birthing institutions. Deferred cord clamping and other evidenced-based practices provide protective benefits to infants and birthers. These small steps can lead to more meaningful overall improvements in neonatal and infant morbidity and mortality. Data on DCC use in hospitals should be publicly available for easy viewing by prospective patients. Deferred cord clamping beneficial and should be standard practice for births in the United States.

Data availability

Not applicable. This paper does not contain collected data.

Abbreviations

Deferred Cord Clamping

Maternity Practices in Infant Nutrition and Care

Intraventricular Hemorrhage

American College of Obstetrics and Gynecologists

American Academy of Pediatrics

Neonatal Resuscitation Program

World Health Organization

Centers for Disease Control and Prevention

Brocato B, Holliday N, Whitehurst RMJ, Lewis D, Varner S. Delayed Cord Clamping in Preterm Neonates: A Review of Benefits and Risks. Obstet Gynecol Surv . 2016;71(1):39. doi:10.1097/OGX.0000000000000263

Chiruvolu A, Mallett LH, Govande VP, Raju VN, Hammonds K, Katheria AC. Variations in umbilical cord clamping practices in the United States: a national survey of neonatologists. J Matern Fetal Neonatal Med . 2022;35(19):3646–3652. doi:10.1080/14767058.2020.1836150

Villeneuve A, Arsenault V, Lacroix J, Tucci M. Neonatal red blood cell transfusion. Vox Sang . 2021;116(4):366–378. doi:10.1111/vox.13036

Andersson O, Lindquist B, Lindgren M, Stjernqvist K, Domellöf M, Hellström-Westas L. Effect of Delayed Cord Clamping on Neurodevelopment at 4 Years of Age: A Randomized Clinical Trial. JAMA Pediatr . 2015;169(7):631–638. doi:10.1001/jamapediatrics.2015.0358

McDonald SJ, Middleton P, Dowswell T, Morris PS. Effect of timing of umbilical cord clamping of term infants on maternal and neonatal outcomes. Cochrane Database Syst Rev . 2013;(7). doi:10.1002/14651858.CD004074.pub3

Peberdy L, Young J, Massey D, Kearney L. Integrated review of the knowledge, attitudes, and practices of maternity health care professionals concerning umbilical cord clamping. Birth Berkeley Calif . 2022;49(4):595–615. doi:10.1111/birt.12647

Leslie MS, Erickson-Owens D, Cseh M. The Evolution of Individual Maternity Care Providers to Delayed Cord Clamping: Is It the Evidence? J Midwifery Womens Health . 2015;60(5):561–569. doi:10.1111/jmwh.12333

CDC. Coronavirus Disease 2019 (COVID-19). Centers for Disease Control and Prevention. Published February 11, 2020. Accessed June 9, 2020. https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/groups-at-higher-risk.html

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Acknowledgements

Leslie H. Lindner, M.D. disclosed a consultant and speaker position for Gynesonics, Redwood City, CA.

Not applicable. The research team did not receive funding for this paper.

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Kranti C. Rumalla, Christi M. Walsh & Martin A. Makary

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Leslie Hansen-Lindner

Johns Hopkins Carey Business School, Baltimore, MD, USA

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Rumalla, K.C., Hansen-Lindner, L., Walsh, C.M. et al. How to improve newborn outcomes in 60 s—delay clamping the umbilical cord. BMC Pregnancy Childbirth 24 , 534 (2024). https://doi.org/10.1186/s12884-024-06467-2

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Received : 16 May 2023

Accepted : 29 March 2024

Published : 14 August 2024

DOI : https://doi.org/10.1186/s12884-024-06467-2

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• Deferred cord clamping
• Infant mortality

BMC Pregnancy and Childbirth

ISSN: 1471-2393

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